Healthcare Provider Details

I. General information

NPI: 1740037498
Provider Name (Legal Business Name): MYNDFULL CARE MANAGEMENT COLORADO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2024
Last Update Date: 05/01/2024
Certification Date: 05/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 FILLMORE STREET 5TH FLOOR OFFICE 522
DENVER CO
80206
US

IV. Provider business mailing address

9436 W LAKE MEAD BLVD SUITE 5 PMB 1113
LAS VEGAS NV
89134-8340
US

V. Phone/Fax

Practice location:
  • Phone: 855-839-8878
  • Fax:
Mailing address:
  • Phone: 855-839-8878
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TEJA SINGH
Title or Position: CEO/OWNER
Credential:
Phone: 855-839-8878