Healthcare Provider Details

I. General information

NPI: 1144545997
Provider Name (Legal Business Name): BETHANY MICHELLE CARVAJAL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BETHANY MICHELLE GRIEGO

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 W 6TH AVE
DENVER CO
80204-5182
US

IV. Provider business mailing address

7115 WELFORD PL
CASTLE PINES CO
80108-3468
US

V. Phone/Fax

Practice location:
  • Phone: 303-602-8340
  • Fax:
Mailing address:
  • Phone: 720-771-9177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number52395
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: