Healthcare Provider Details

I. General information

NPI: 1114358181
Provider Name (Legal Business Name): MARGARET PROFITA VILLANO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2013
Last Update Date: 10/10/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E 19TH AVE STE 4350
DENVER CO
80218-1253
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-228-1240
  • Fax:
Mailing address:
  • Phone: 720-754-4800
  • Fax: 720-754-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3844
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: