Healthcare Provider Details

I. General information

NPI: 1902254675
Provider Name (Legal Business Name): DAVID GONZALO ROJAS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2016
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12631 E 17TH AVE
DENVER CO
80045-2527
US

IV. Provider business mailing address

5621 E AMHERST AVE
DENVER CO
80222-7014
US

V. Phone/Fax

Practice location:
  • Phone: 765-669-2466
  • Fax:
Mailing address:
  • Phone: 765-669-2466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberDR.0066668
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: