Healthcare Provider Details

I. General information

NPI: 1831713478
Provider Name (Legal Business Name): OLIVIA CHRISTINE PUCCIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2020
Last Update Date: 06/09/2023
Certification Date: 06/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9094 E MINERAL CIR STE 120
CENTENNIAL CO
80112-7201
US

IV. Provider business mailing address

2928 IOLA ST
DENVER CO
80238-3199
US

V. Phone/Fax

Practice location:
  • Phone: 303-779-5437
  • Fax:
Mailing address:
  • Phone: 328-603-5458
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0070948
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: