Healthcare Provider Details

I. General information

NPI: 1851577357
Provider Name (Legal Business Name): ROBERT MORANDI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 01/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 COLORADO BLVD # 318
DENVER CO
80206-4084
US

IV. Provider business mailing address

10537 PENNS CREEK CT
LAS VEGAS NV
89135-2085
US

V. Phone/Fax

Practice location:
  • Phone: 303-339-7408
  • Fax:
Mailing address:
  • Phone: 702-493-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224Z00000X
TaxonomyOccupational Therapy Assistant
License Number1187
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: