Healthcare Provider Details

I. General information

NPI: 1720394752
Provider Name (Legal Business Name): MRS. LISA CORDEIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2010
Last Update Date: 08/27/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 S DAHLIA ST #300
DENVER CO
80222-4758
US

IV. Provider business mailing address

700 N. COLORADO BOULEVARD #334
DENVER CO
80206
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-8360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: