Healthcare Provider Details

I. General information

NPI: 1699682179
Provider Name (Legal Business Name): MARICRUZ DE LA ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5024 FONTANA COURT
AURORA CO
80012
US

IV. Provider business mailing address

5024 FONTANA CT
DENVER CO
80239-4277
US

V. Phone/Fax

Practice location:
  • Phone: 720-338-9961
  • Fax:
Mailing address:
  • Phone: 720-338-9961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: