Healthcare Provider Details

I. General information

NPI: 1861631319
Provider Name (Legal Business Name): CARINA P KUGELMAS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARINA PENER MD

II. Dates (important events)

Enumeration Date: 02/06/2009
Last Update Date: 03/30/2021
Certification Date: 03/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

11500 E DORADO AVE
ENGLEWOOD CO
80111-4144
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6000
  • Fax:
Mailing address:
  • Phone: 720-352-0679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number38734
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0038734
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: