Healthcare Provider Details

I. General information

NPI: 1518926005
Provider Name (Legal Business Name): SOUTH DENVER OBSTETRICS & GYNECOLOGY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2006
Last Update Date: 06/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7780 S BROADWAY STE 280
LITTLETON CO
80122-2633
US

IV. Provider business mailing address

8055 E TUFTS AVE STE 230
DENVER CO
80237-2854
US

V. Phone/Fax

Practice location:
  • Phone: 303-738-1100
  • Fax: 303-738-1310
Mailing address:
  • Phone: 720-439-2456
  • Fax: 720-572-5112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207VX0000X
TaxonomyObstetrics Physician
License Number
License Number State

VIII. Authorized Official

Name: CANDICE R CHACON-JARAMILLO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 720-439-2456