Healthcare Provider Details

I. General information

NPI: 1558536938
Provider Name (Legal Business Name): CLINICA CAMPESINA FAMILY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2008
Last Update Date: 01/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 S PUBLIC RD # 100
LAFAYETTE CO
80026-7093
US

IV. Provider business mailing address

1735 S PUBLIC RD STE 203
LAFAYETTE CO
80026-7093
US

V. Phone/Fax

Practice location:
  • Phone: 303-665-9310
  • Fax: 303-328-2691
Mailing address:
  • Phone: 303-665-9310
  • Fax: 303-328-2691

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License Number322
License Number StateCO

VIII. Authorized Official

Name: SIMON SMITH
Title or Position: CEO
Credential:
Phone: 303-665-2962