Healthcare Provider Details

I. General information

NPI: 1225514771
Provider Name (Legal Business Name): JUAN M ORRACA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 07/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1699 S COLORADO BLVD UNIT M
DENVER CO
80222-4021
US

IV. Provider business mailing address

1017 S BIRCH ST APT 501B
GLENDALE CO
80246-2522
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-1471
  • Fax:
Mailing address:
  • Phone: 720-787-2574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number0002229
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: