Healthcare Provider Details

I. General information

NPI: 1467916015
Provider Name (Legal Business Name): WESTIN SURGICAL ASSISTANTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2019
Last Update Date: 01/31/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 PRAIRIE CENTER PKWY
BRIGHTON CO
80601-4006
US

IV. Provider business mailing address

992 S. 4TH AVE SUITE 100 #451
BRIGHTON CO
80601-6803
US

V. Phone/Fax

Practice location:
  • Phone: 303-498-1600
  • Fax:
Mailing address:
  • Phone: 303-564-1781
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: RICHARD TED ONTIVEROS
Title or Position: OWNER / SURGICAL ASSISTANT
Credential: CST, SA-C
Phone: 303-564-1781