Healthcare Provider Details

I. General information

NPI: 1598951386
Provider Name (Legal Business Name): DIANNE CATHERINE BUNNEY GALLEGOS M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DIANNE BUNNEY

II. Dates (important events)

Enumeration Date: 09/14/2007
Last Update Date: 04/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1666 S STUART ST
DENVER CO
80219-4457
US

IV. Provider business mailing address

1666 S STUART ST
DENVER CO
80219-4457
US

V. Phone/Fax

Practice location:
  • Phone: 303-842-1512
  • Fax: 303-936-4424
Mailing address:
  • Phone: 303-842-1512
  • Fax: 303-936-4424

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number414
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: