Healthcare Provider Details

I. General information

NPI: 1407446321
Provider Name (Legal Business Name): ANNEST, SYNN, NOWAK AND MUBARAK, PROF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2021
Last Update Date: 01/25/2021
Certification Date: 01/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 E FLORIDA AVE
DENVER CO
80222-3620
US

IV. Provider business mailing address

4105 E FLORIDA AVE
DENVER CO
80222-3620
US

V. Phone/Fax

Practice location:
  • Phone: 303-539-0736
  • Fax: 303-539-0737
Mailing address:
  • Phone: 303-539-0736
  • Fax: 303-539-0737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DESIREE ROBERTS
Title or Position: DELEGATED OFFICIAL
Credential:
Phone: 720-880-7839