Healthcare Provider Details

I. General information

NPI: 1215806468
Provider Name (Legal Business Name): PREMIER INTEGRATIVE & COGNITIVE MEDICAL INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2025
Last Update Date: 11/04/2025
Certification Date: 11/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S COLORADO BLVD STE 860
DENVER CO
80246-1252
US

IV. Provider business mailing address

8 CHERRY HILLS DR
ENGLEWOOD CO
80113-4812
US

V. Phone/Fax

Practice location:
  • Phone: 808-315-1922
  • Fax:
Mailing address:
  • Phone: 808-315-1922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084B0040X
TaxonomyBehavioral Neurology & Neuropsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LYNN PUANA
Title or Position: MANAGING MEMBER
Credential:
Phone: 808-315-1922