Healthcare Provider Details

I. General information

NPI: 1104378231
Provider Name (Legal Business Name): RACHEL GOREN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 10/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 N GRANT ST
DENVER CO
80203-2907
US

IV. Provider business mailing address

980 N GRANT ST
DENVER CO
80203-2907
US

V. Phone/Fax

Practice location:
  • Phone: 303-832-3668
  • Fax:
Mailing address:
  • Phone: 303-832-3668
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0010059
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: