Healthcare Provider Details

I. General information

NPI: 1841663176
Provider Name (Legal Business Name): MINDY PELLEGRINO MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 11/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3339 W 38TH AVE
DENVER CO
80211-1909
US

IV. Provider business mailing address

3339 W 38TH AVE
DENVER CO
80211-1909
US

V. Phone/Fax

Practice location:
  • Phone: 303-619-5475
  • Fax:
Mailing address:
  • Phone: 303-619-5475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: