Healthcare Provider Details

I. General information

NPI: 1316365026
Provider Name (Legal Business Name): AUDRA VERONICA DICARO M.M.SC.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13952 DENVER WEST PKWY BUILDING 53 #100
LAKEWOOD CO
80401-3141
US

IV. Provider business mailing address

382 S ARTHUR AVE
LOUISVILLE CO
80027-3094
US

V. Phone/Fax

Practice location:
  • Phone: 303-604-5000
  • Fax:
Mailing address:
  • Phone: 303-604-5000
  • Fax: 720-890-0364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0004735
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: