Healthcare Provider Details

I. General information

NPI: 1568290575
Provider Name (Legal Business Name): CRANIAL COUTURE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2024
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 N BROADWAY
DENVER CO
80203-2105
US

IV. Provider business mailing address

4860 CHAMBERS RD # 92
DENVER CO
80239-5152
US

V. Phone/Fax

Practice location:
  • Phone: 303-725-8833
  • Fax:
Mailing address:
  • Phone: 202-725-8833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: VICKI HOWAD
Title or Position: CRANIAL PROTHESIS SPECIALIST
Credential:
Phone: 720-363-3964