Healthcare Provider Details

I. General information

NPI: 1538110531
Provider Name (Legal Business Name): JUSTINE MARIE MIRALDI CST/SA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2006
Last Update Date: 04/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ONEIDA ST
DENVER CO
80220-6075
US

IV. Provider business mailing address

200 ONEIDA ST
DENVER CO
80220-6075
US

V. Phone/Fax

Practice location:
  • Phone: 303-596-5774
  • Fax: 720-274-2828
Mailing address:
  • Phone: 303-596-5774
  • Fax: 720-274-2828

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: