Healthcare Provider Details

I. General information

NPI: 1376552000
Provider Name (Legal Business Name): COLORADO LASER AND VEIN PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 S HOLLY ST SUITE 111
CENTENNIAL CO
80122-4005
US

IV. Provider business mailing address

8120 S HOLLY ST SUITE 111
CENTENNIAL CO
80122-4005
US

V. Phone/Fax

Practice location:
  • Phone: 303-741-4060
  • Fax: 720-489-6047
Mailing address:
  • Phone: 303-741-4060
  • Fax: 720-489-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number37416
License Number StateCO

VIII. Authorized Official

Name: DAVID SIROOSPOUR
Title or Position: OWNER
Credential: M.D.
Phone: 303-741-4060