Healthcare Provider Details

I. General information

NPI: 1144599937
Provider Name (Legal Business Name): LISA SZCYPINSKI RDH, OM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2011
Last Update Date: 12/22/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

965 S. COLORADO BLVD. SUITE 104
DENVER CO
80246
US

IV. Provider business mailing address

13030 W. 30TH DRIVE
GOLDEN CO
80401
US

V. Phone/Fax

Practice location:
  • Phone: 720-560-5172
  • Fax: 720-545-9884
Mailing address:
  • Phone: 720-560-5172
  • Fax: 720-545-9884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number902927
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: