Healthcare Provider Details

I. General information

NPI: 1609040773
Provider Name (Legal Business Name): SPANISH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/18/2008
Last Update Date: 02/06/2020
Certification Date: 02/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 MORRISON RD, UNIT 8
DENVER CO
80219
US

IV. Provider business mailing address

4200 MORRISON RD, UNIT 8
DENVER CO
80219
US

V. Phone/Fax

Practice location:
  • Phone: 303-934-3040
  • Fax: 303-934-4188
Mailing address:
  • Phone: 303-934-3040
  • Fax: 303-934-4188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number6635
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number6635
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number6635
License Number StateCO

VIII. Authorized Official

Name: ALFONSO CASTILLO
Title or Position: DIRECTOR
Credential:
Phone: 720-225-7157