Healthcare Provider Details

I. General information

NPI: 1376516252
Provider Name (Legal Business Name): JONATHAN ISAAC RITVO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 02/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S CHERRY ST #650
DENVER CO
80246-1325
US

IV. Provider business mailing address

501 S CHERRY ST #650
DENVER CO
80246-1325
US

V. Phone/Fax

Practice location:
  • Phone: 303-333-3163
  • Fax: 303-399-0232
Mailing address:
  • Phone: 303-333-3163
  • Fax: 303-399-0232

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number19307
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code2084P0802X
TaxonomyAddiction Psychiatry Physician
License Number19307
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: