Healthcare Provider Details

I. General information

NPI: 1457286544
Provider Name (Legal Business Name): MEDLOG LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 CALIFORNIA ST
DENVER CO
80202-3402
US

IV. Provider business mailing address

1500 N GRANT ST # 10885
DENVER CO
80203-1859
US

V. Phone/Fax

Practice location:
  • Phone: 551-350-2896
  • Fax: 214-286-6037
Mailing address:
  • Phone: 551-350-2896
  • Fax: 214-286-6037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BD1200X
TaxonomyDialysis Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: RUBEN PEREZ
Title or Position: OWNER
Credential:
Phone: 551-350-2896