Healthcare Provider Details

I. General information

NPI: 1598889313
Provider Name (Legal Business Name): JULIETA LOPEZ BURNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIETA LOPEZ

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 10/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 CAPADARO CT
MONUMENT CO
80132-3402
US

IV. Provider business mailing address

1625 CAPADARO CT
MONUMENT CO
80132-3402
US

V. Phone/Fax

Practice location:
  • Phone: 719-641-1302
  • Fax:
Mailing address:
  • Phone: 719-641-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License NumberPTL9348
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number9348
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: