Healthcare Provider Details

I. General information

NPI: 1063599256
Provider Name (Legal Business Name): SAGUARO FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1189 S PERRY ST SUITE 220
CASTLE ROCK CO
80104-1958
US

IV. Provider business mailing address

1189 S PERRY ST SUITE 220
CASTLE ROCK CO
80104-1958
US

V. Phone/Fax

Practice location:
  • Phone: 303-688-8108
  • Fax:
Mailing address:
  • Phone: 303-688-8108
  • Fax: 303-688-9122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57204
License Number StateCO

VIII. Authorized Official

Name: MRS. GAIL LADEAN CROSS
Title or Position: PRESIDENT
Credential: RN-CNP
Phone: 303-688-8108