Healthcare Provider Details

I. General information

NPI: 1629428982
Provider Name (Legal Business Name): ZUMAYA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 09/06/2023
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1143 SANTA FE DR
DENVER CO
80204-3543
US

IV. Provider business mailing address

31481 UPPER BEAR CREEK RD
EVERGREEN CO
80439-7818
US

V. Phone/Fax

Practice location:
  • Phone: 559-307-1800
  • Fax:
Mailing address:
  • Phone: 559-307-1800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number09924043
License Number StateCO

VIII. Authorized Official

Name: GLADYS R VILLA
Title or Position: PROPRIETOR
Credential:
Phone: 559-307-1800