Healthcare Provider Details

I. General information

NPI: 1285761262
Provider Name (Legal Business Name): LISA M MONDRAGON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 20TH AVE
DENVER CO
80205-5423
US

IV. Provider business mailing address

18385 E IDAHO PL
AURORA CO
80017-4304
US

V. Phone/Fax

Practice location:
  • Phone: 303-764-5336
  • Fax:
Mailing address:
  • Phone: 303-650-0261
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: