Healthcare Provider Details

I. General information

NPI: 1972556561
Provider Name (Legal Business Name): FRUITA FAMILY MEDICINE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2330 E ALCOVE DR
GRAND JUNCTION CO
81503-1485
US

IV. Provider business mailing address

2330 E ALCOVE DR
GRAND JUNCTION CO
81503-1485
US

V. Phone/Fax

Practice location:
  • Phone: 970-201-3467
  • Fax:
Mailing address:
  • Phone: 970-201-3467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANGELA K GAO
Title or Position: OWNER
Credential: D.O.
Phone: 970-201-3467