Healthcare Provider Details

I. General information

NPI: 1992971402
Provider Name (Legal Business Name): ROSE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2008
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E 9TH AVE SUITE 260
DENVER CO
80220-3901
US

IV. Provider business mailing address

4545 E 9TH AVE SUITE 260
DENVER CO
80220-3901
US

V. Phone/Fax

Practice location:
  • Phone: 303-320-7366
  • Fax: 303-320-7367
Mailing address:
  • Phone: 303-320-7366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number33467
License Number StateCO

VIII. Authorized Official

Name: HEATHER KEY
Title or Position: OFFICE MANAGER
Credential:
Phone: 303-320-7366