Healthcare Provider Details

I. General information

NPI: 1598007833
Provider Name (Legal Business Name): BRYN ALEXANDRA GONZALES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2013
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4507
US

IV. Provider business mailing address

1100 FEDERAL BLVD
DENVER CO
80204-3219
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-4200
  • Fax:
Mailing address:
  • Phone: 303-436-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberDR.0056743
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: