Healthcare Provider Details

I. General information

NPI: 1982978268
Provider Name (Legal Business Name): JOSEPH A TESORIERO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2012
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 W 2ND PL
LAKEWOOD CO
80228-1527
US

IV. Provider business mailing address

1819 DENVER WEST DR STE 101
LAKEWOOD CO
80401-3172
US

V. Phone/Fax

Practice location:
  • Phone: 720-321-0000
  • Fax:
Mailing address:
  • Phone: 303-223-4448
  • Fax: 720-501-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberDR.0065957
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberDR.0065957
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: