Healthcare Provider Details

I. General information

NPI: 1043036247
Provider Name (Legal Business Name): ADRIANA ALONDRA BANUELOS-BELLOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/03/2024
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 N CLAYTON ST
DENVER CO
80205-4738
US

IV. Provider business mailing address

990 NAVAJO ST APT 206
DENVER CO
80204-3988
US

V. Phone/Fax

Practice location:
  • Phone: 303-726-2612
  • Fax:
Mailing address:
  • Phone: 720-254-8678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: