Healthcare Provider Details

I. General information

NPI: 1316696784
Provider Name (Legal Business Name): JOSEPH GOMES ANDRADE DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 29TH ST STE 500
BOULDER CO
80303-2357
US

IV. Provider business mailing address

777 29TH ST STE 500
BOULDER CO
80303-2357
US

V. Phone/Fax

Practice location:
  • Phone: 970-310-3406
  • Fax:
Mailing address:
  • Phone: 970-310-3406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberDR.0077761
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number20A21760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: