Healthcare Provider Details

I. General information

NPI: 1669293619
Provider Name (Legal Business Name): KLARISANA PHYSICIAN SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 09/11/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 S VINE ST STE 100
CENTENNIAL CO
80121-2740
US

IV. Provider business mailing address

8670 WOLFF CT STE 270
WESTMINSTER CO
80031-6956
US

V. Phone/Fax

Practice location:
  • Phone: 303-535-7548
  • Fax:
Mailing address:
  • Phone: 844-455-2747
  • Fax: 888-504-2390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ALYSSA SOTO
Title or Position: MANAGER OF REVENUE CYCLE
Credential:
Phone: 303-535-7548