Healthcare Provider Details

I. General information

NPI: 1508527763
Provider Name (Legal Business Name): TARA RECHTENBAUGH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 01/10/2022
Certification Date: 01/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 INVERNESS DR W STE 400
ENGLEWOOD CO
80112-5072
US

IV. Provider business mailing address

16742 RINKER WAY
BROOMFIELD CO
80023-4684
US

V. Phone/Fax

Practice location:
  • Phone: 970-373-8095
  • Fax:
Mailing address:
  • Phone: 303-727-0615
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberAPN.0997251
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: