Healthcare Provider Details

I. General information

NPI: 1235742453
Provider Name (Legal Business Name): WILLIAM JOSEPH DUCA CSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2020
Last Update Date: 08/27/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1551 LARIMER ST APT 2204
DENVER CO
80202-1636
US

IV. Provider business mailing address

1551 LARIMER ST APT 2204
DENVER CO
80202-1636
US

V. Phone/Fax

Practice location:
  • Phone: 719-293-4999
  • Fax:
Mailing address:
  • Phone: 719-293-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License NumberF01510
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: