Healthcare Provider Details

I. General information

NPI: 1700359536
Provider Name (Legal Business Name): JOSE ALBERTO DIAZ LEO NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2019
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 E COLFAX AVE
DENVER CO
80220-1515
US

IV. Provider business mailing address

1932 KINGSTON ST
AURORA CO
80010-2510
US

V. Phone/Fax

Practice location:
  • Phone: 303-962-5317
  • Fax: 303-832-7823
Mailing address:
  • Phone: 303-962-5317
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.1634524
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPN.0994212-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: