Healthcare Provider Details

I. General information

NPI: 1770326472
Provider Name (Legal Business Name): FRONTERA MEDICAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2024
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1517 BLAKE ST STE 250
DENVER CO
80202-5943
US

IV. Provider business mailing address

PO BOX 13096
DENVER CO
80201-3296
US

V. Phone/Fax

Practice location:
  • Phone: 785-410-8515
  • Fax:
Mailing address:
  • Phone: 785-410-8515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: NATE PHILLIPS
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 785-410-8515