Healthcare Provider Details

I. General information

NPI: 1184202301
Provider Name (Legal Business Name): NIMA AVIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 06/27/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 AUTOMATION WAY
FORT COLLINS CO
80525-5737
US

IV. Provider business mailing address

3702 AUTOMATION WAY
FORT COLLINS CO
80525-5737
US

V. Phone/Fax

Practice location:
  • Phone: 970-224-2985
  • Fax:
Mailing address:
  • Phone: 970-224-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0075674
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: