Healthcare Provider Details

I. General information

NPI: 1922598200
Provider Name (Legal Business Name): ROBERT JOSEPH MONGEON III CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2018
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7408 S ALKIRE ST APT 303
LITTLETON CO
80127-3265
US

IV. Provider business mailing address

7408 S ALKIRE ST APT 303
LITTLETON CO
80127-3265
US

V. Phone/Fax

Practice location:
  • Phone: 720-401-8152
  • Fax:
Mailing address:
  • Phone: 720-401-8152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: