Healthcare Provider Details

I. General information

NPI: 1679837918
Provider Name (Legal Business Name): VISTA NEUROMONITORING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10099 RIDGEGATE PKWY SUITE 480
LONETREE CO
80124-5531
US

IV. Provider business mailing address

10099 RIDGEGATE PKWY SUITE 480
LONETREE CO
80124-5531
US

V. Phone/Fax

Practice location:
  • Phone: 303-790-1800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0500X
TaxonomyEEG Specialist/Technologist
License Number
License Number State

VIII. Authorized Official

Name: MS. NATALIA KELLEY
Title or Position: MANAGER
Credential:
Phone: 303-790-1800