Healthcare Provider Details

I. General information

NPI: 1710054143
Provider Name (Legal Business Name): ANDREA PATT MOON P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7280 LAGAE RD STE J
CASTLE PINES CO
80108-9454
US

IV. Provider business mailing address

1805 SHEA CENTER DR STE 450
HIGHLANDS RANCH CO
80129-2255
US

V. Phone/Fax

Practice location:
  • Phone: 303-814-0505
  • Fax: 303-814-6491
Mailing address:
  • Phone: 303-357-2559
  • Fax: 303-814-0505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2104
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: