Healthcare Provider Details

I. General information

NPI: 1376720391
Provider Name (Legal Business Name): SIGNATURE HOLDINGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 06/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 UNIVERSITY BLVD UNIT 102
DENVER CO
80206-4657
US

IV. Provider business mailing address

201 UNIVERSITY BLVD UNIT 102
DENVER CO
80206-4657
US

V. Phone/Fax

Practice location:
  • Phone: 303-355-1496
  • Fax: 303-388-7457
Mailing address:
  • Phone: 303-355-1496
  • Fax: 303-388-7457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number4253656
License Number StateCO

VIII. Authorized Official

Name: MRS. RIMMA GUZMAN
Title or Position: MANAGER
Credential:
Phone: 303-355-1496