Healthcare Provider Details

I. General information

NPI: 1740835602
Provider Name (Legal Business Name): ANDRES ALEJANDRO PAREDES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2019
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 VINCENT ST SPC BASE
COLORADO SPRINGS CO
80914-1541
US

IV. Provider business mailing address

220 FALCON PKWY
SCHRIEVER AFB CO
80912-5005
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-2273
  • Fax:
Mailing address:
  • Phone: 719-524-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: