Healthcare Provider Details

I. General information

NPI: 1114292786
Provider Name (Legal Business Name): MS. PATRICIA MORENO-CABRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2012
Last Update Date: 03/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6255 QUEBEC PKWY
COMMERCE CITY CO
80022-4812
US

IV. Provider business mailing address

203 S ROLLIE AVE BILLING DEPT - CREDENTIALIST
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 303-286-6755
  • Fax: 303-286-4970
Mailing address:
  • Phone: 303-286-4560
  • Fax: 303-286-4589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD3845
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN.00202526
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: