Healthcare Provider Details

I. General information

NPI: 1447964770
Provider Name (Legal Business Name): NEW START NEURO CARE, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2023
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

933 16TH ST SW APT 1
LOVELAND CO
80537-7095
US

IV. Provider business mailing address

933 16TH ST SW APT 1
LOVELAND CO
80537-7095
US

V. Phone/Fax

Practice location:
  • Phone: 970-800-9547
  • Fax:
Mailing address:
  • Phone: 561-635-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EUNICE CORDOBA
Title or Position: PHYSICIAN
Credential: MD
Phone: 561-635-6153