Healthcare Provider Details

I. General information

NPI: 1003114174
Provider Name (Legal Business Name): ROCKY MOUNTAIN PEDIATRIC NUTRITION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2011
Last Update Date: 03/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1776 S JACKSON ST SUITE 1007
DENVER CO
80210-3801
US

IV. Provider business mailing address

1260 S YORK ST
DENVER CO
80210-1913
US

V. Phone/Fax

Practice location:
  • Phone: 303-704-2298
  • Fax: 303-777-5619
Mailing address:
  • Phone: 303-704-2298
  • Fax: 303-777-5619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1004X
TaxonomyPediatric Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: MRS. CATHERINE MICHELLE SANTANGELO
Title or Position: PEDIATRIC DIETITIAN
Credential: RD
Phone: 303-704-2298