Healthcare Provider Details

I. General information

NPI: 1235731688
Provider Name (Legal Business Name): CHRISTOPHER ANAYA CAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/11/2020
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W ABRIENDO AVE
PUEBLO CO
81004-1870
US

IV. Provider business mailing address

831 BEULAH AVE
PUEBLO CO
81004-1703
US

V. Phone/Fax

Practice location:
  • Phone: 719-621-1929
  • Fax: 719-621-4974
Mailing address:
  • Phone: 719-821-2344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberACC.0998668
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: