Healthcare Provider Details

I. General information

NPI: 1881131654
Provider Name (Legal Business Name): 1ST ALLERGY ASTHMA AND PEDIATRICS TOO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2017
Last Update Date: 01/31/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3150 E 3RD AVE STE 300
DENVER CO
80206-5247
US

IV. Provider business mailing address

6801 S YOSEMITE ST
CENTENNIAL CO
80112-1406
US

V. Phone/Fax

Practice location:
  • Phone: 720-870-2414
  • Fax: 720-870-2517
Mailing address:
  • Phone: 303-773-9000
  • Fax: 303-770-1449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: RONI G MUSHOVIC
Title or Position: CEO
Credential:
Phone: 303-773-9000