Healthcare Provider Details

I. General information

NPI: 1457191348
Provider Name (Legal Business Name): RAQUEL TENDILLA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 06/30/2024
Certification Date: 06/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15101 E ILIFF AVE STE 140
AURORA CO
80014-4548
US

IV. Provider business mailing address

4584 PERTH ST
DENVER CO
80249-8074
US

V. Phone/Fax

Practice location:
  • Phone: 720-878-7055
  • Fax:
Mailing address:
  • Phone: 720-314-2251
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN.0999633-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: