Healthcare Provider Details

I. General information

NPI: 1740153733
Provider Name (Legal Business Name): GUOTIANYUAN ZU
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2025
Last Update Date: 09/25/2025
Certification Date: 09/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

1293 S ALTON CT
DENVER CO
80247-2323
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-2000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1683786
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: