Healthcare Provider Details

I. General information

NPI: 1790784775
Provider Name (Legal Business Name): PETER WARREN ALDORETTA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 04/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

IV. Provider business mailing address

2635 N 7TH ST
GRAND JUNCTION CO
81501-8209
US

V. Phone/Fax

Practice location:
  • Phone: 970-298-2200
  • Fax: 970-298-2222
Mailing address:
  • Phone: 970-298-2279
  • Fax: 970-298-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number10319R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number30059
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: