Healthcare Provider Details

I. General information

NPI: 1245716091
Provider Name (Legal Business Name): PEDRO FELIX DIAZ RAMOS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2018
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 BLUE SPRUCE DR
FORT COLLINS CO
80524-5427
US

IV. Provider business mailing address

203 S ROLLIE AVE
FORT LUPTON CO
80621-1508
US

V. Phone/Fax

Practice location:
  • Phone: 970-494-4040
  • Fax: 970-494-4050
Mailing address:
  • Phone: 303-892-6401
  • Fax: 303-892-1511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCSW.09925891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: