Healthcare Provider Details

I. General information

NPI: 1609157700
Provider Name (Legal Business Name): GEORGIA RONDA CNIM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 S ALBION ST SUITE 425
DENVER CO
80222-4008
US

IV. Provider business mailing address

31500 GRAPE ST #3 #501
LAKE ELSINORE CA
92532-9702
US

V. Phone/Fax

Practice location:
  • Phone: 720-214-2549
  • Fax:
Mailing address:
  • Phone: 720-214-2549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: