Healthcare Provider Details

I. General information

NPI: 1083985949
Provider Name (Legal Business Name): AFFA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9777 BUCKNELL WAY
HIGHLANDS RANCH CO
80129-4395
US

IV. Provider business mailing address

9777 BUCKNELL WAY
HIGHLANDS RANCH CO
80129-4395
US

V. Phone/Fax

Practice location:
  • Phone: 281-462-1285
  • Fax: 281-462-1554
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE FLANNERY
Title or Position: OWNER
Credential:
Phone: 281-462-1285