Healthcare Provider Details

I. General information

NPI: 1619200466
Provider Name (Legal Business Name): ONDI ANDREA CROSSLAND HOZIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANDREA CROSSLAND COOKE

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

925 S NIAGARA ST SUITE 370
DENVER CO
80224-1683
US

IV. Provider business mailing address

925 S NIAGARA ST SUITE 370
DENVER CO
80224-1683
US

V. Phone/Fax

Practice location:
  • Phone: 303-321-2383
  • Fax: 303-223-3288
Mailing address:
  • Phone: 303-321-2383
  • Fax: 303-223-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA 0003973
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: