Healthcare Provider Details

I. General information

NPI: 1548754419
Provider Name (Legal Business Name): MALIA G SWANSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MALIA ANNE GUY

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 08/03/2023
Certification Date: 08/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 13TH ST
BOULDER CO
80304-4104
US

IV. Provider business mailing address

1735 S PUBLIC RD STE 203
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-650-4460
  • Fax:
Mailing address:
  • Phone: 303-665-3036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberL.4744
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberMD.39381
License Number StateAL
# 4
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number39381
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR0069167
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: