Healthcare Provider Details

I. General information

NPI: 1225261746
Provider Name (Legal Business Name): DIANA ANA CER DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2009
Last Update Date: 10/23/2022
Certification Date: 10/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E HAMPDEN AVE
ENGLEWOOD CO
80113-2702
US

IV. Provider business mailing address

5600 S QUEBEC ST
GREENWOOD VILLAGE CO
80111-2207
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-5643
  • Fax:
Mailing address:
  • Phone: 303-953-5643
  • Fax: 303-436-2710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberDR.0067916
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0011001
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: