Healthcare Provider Details

I. General information

NPI: 1700411451
Provider Name (Legal Business Name): ANGEL STOUT-PADOVANI RPA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2020
Last Update Date: 03/03/2020
Certification Date: 03/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 303-854-9888
  • Fax: 720-501-5199
Mailing address:
  • Phone: 303-416-1360
  • Fax: 720-501-5199

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code243U00000X
TaxonomyRadiology Practitioner Assistant
License Number09M01394
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: