Healthcare Provider Details

I. General information

NPI: 1770022030
Provider Name (Legal Business Name): MATT FRANZINO PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2017
Last Update Date: 02/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6660 TIMBERLINE RD 110
HIGHLANDS RANCH CO
80130-5345
US

IV. Provider business mailing address

7310 S ALTON WAY STE. 6L
CENTENNIAL CO
80112-2334
US

V. Phone/Fax

Practice location:
  • Phone: 303-683-4500
  • Fax:
Mailing address:
  • Phone: 303-790-4495
  • Fax: 720-488-1988

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number0014017
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: