Healthcare Provider Details

I. General information

NPI: 1609284611
Provider Name (Legal Business Name): CHANELL CHARAPATA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 E HAMPDEN AVE #515
ENGLEWOOD CO
80113-2736
US

IV. Provider business mailing address

4900 S MONACO ST #210
DENVER CO
80237-3486
US

V. Phone/Fax

Practice location:
  • Phone: 303-209-2503
  • Fax: 303-761-0803
Mailing address:
  • Phone: 303-209-2503
  • Fax: 303-761-0803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4024
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: