Healthcare Provider Details

I. General information

NPI: 1134008337
Provider Name (Legal Business Name): SILVER MOUNTAIN PEDIATRICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2025
Last Update Date: 03/20/2026
Certification Date: 03/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 COLORADO AVE UNIT 2A
DURANGO CO
81301-4761
US

IV. Provider business mailing address

2530 COLORADO AVE UNIT 2A
DURANGO CO
81301-4761
US

V. Phone/Fax

Practice location:
  • Phone: 970-512-5255
  • Fax: 970-615-4981
Mailing address:
  • Phone: 970-512-5255
  • Fax: 970-615-4981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: LAUREN LAQUA
Title or Position: CO-OWNER
Credential: NP
Phone: 662-298-6191