Healthcare Provider Details

I. General information

NPI: 1972142636
Provider Name (Legal Business Name): BRITTANY GOTTO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2019
Last Update Date: 12/29/2019
Certification Date: 12/29/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE ST
DENVER CO
80205-2406
US

IV. Provider business mailing address

3629 W CUSTER PL
DENVER CO
80219-2701
US

V. Phone/Fax

Practice location:
  • Phone: 720-419-2187
  • Fax:
Mailing address:
  • Phone: 712-540-7787
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-107738
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: