Healthcare Provider Details

I. General information

NPI: 1942270806
Provider Name (Legal Business Name): TRACY V CERNIGLIA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2006
Last Update Date: 05/02/2024
Certification Date: 05/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6340 BARNES RD
COLORADO SPRINGS CO
80922-2602
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-2900
  • Fax: 719-570-0601
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0039488
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: