Healthcare Provider Details

I. General information

NPI: 1821876491
Provider Name (Legal Business Name): CARAVITA HEALTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 05/22/2025
Certification Date: 05/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3065 CENTER GREEN DR STE 216
BOULDER CO
80301-2251
US

IV. Provider business mailing address

109 E 17TH ST STE 6178
CHEYENNE WY
82001-4543
US

V. Phone/Fax

Practice location:
  • Phone: 720-910-1410
  • Fax:
Mailing address:
  • Phone: 720-761-1362
  • Fax: 303-484-0429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARIO RAFAEL ANGLADA CORTES
Title or Position: CEO
Credential:
Phone: 720-761-1362