Healthcare Provider Details

I. General information

NPI: 1609162353
Provider Name (Legal Business Name): RISHI ARIOLA-TIRELLA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2011
Last Update Date: 05/07/2024
Certification Date: 05/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1008 MINNEQUA AVE
PUEBLO CO
81004-3733
US

IV. Provider business mailing address

1008 MINNEQUA AVE
PUEBLO CO
81004-3733
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-6630
  • Fax: 719-557-4766
Mailing address:
  • Phone: 719-562-6630
  • Fax: 719-557-4766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number55090
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberDR.0055090
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: