Healthcare Provider Details

I. General information

NPI: 1144563511
Provider Name (Legal Business Name): ROCKY MOUNTAIN PEDIATRIC ENDOCRINOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2013
Last Update Date: 11/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7336 S YOSEMITE ST SUITE 200
CENTENNIAL CO
80112-2340
US

IV. Provider business mailing address

7336 S YOSEMITE ST SUITE 200
CENTENNIAL CO
80112-2340
US

V. Phone/Fax

Practice location:
  • Phone: 720-420-3636
  • Fax: 720-420-3637
Mailing address:
  • Phone: 720-420-3636
  • Fax: 720-420-3637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License Number40168
License Number StateCO

VIII. Authorized Official

Name: DR. ARISTIDES K MANIATIS
Title or Position: PRESIDENT
Credential:
Phone: 720-420-3636