Healthcare Provider Details

I. General information

NPI: 1821262734
Provider Name (Legal Business Name): RONDA J DISNEY RD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2008
Last Update Date: 04/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 S DOWNING ST
DENVER CO
80210
US

IV. Provider business mailing address

DEPARTMENT 1244
DENVER CO
80291-1244
US

V. Phone/Fax

Practice location:
  • Phone: 303-778-5881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: