Healthcare Provider Details

I. General information

NPI: 1134164593
Provider Name (Legal Business Name): PUEBLO CARDIOLOGY ASSOC PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2006
Last Update Date: 07/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3670 PARKER BLVD STE 101
PUEBLO CO
81008-2207
US

IV. Provider business mailing address

3670 PARKER BLVD STE 101
PUEBLO CO
81008-2207
US

V. Phone/Fax

Practice location:
  • Phone: 719-564-1544
  • Fax: 719-924-1593
Mailing address:
  • Phone: 719-564-1544
  • Fax: 719-924-1593

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTIAN THOMAS STJERNHOLM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 719-564-1544