Healthcare Provider Details

I. General information

NPI: 1568534642
Provider Name (Legal Business Name): PUEBLO BONE AND JOINT CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2006
Last Update Date: 04/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1919 W US HIGHWAY 50
PUEBLO CO
81008-1618
US

IV. Provider business mailing address

1919 W US HIGHWAY 50
PUEBLO CO
81008-1618
US

V. Phone/Fax

Practice location:
  • Phone: 719-253-7102
  • Fax: 719-253-7114
Mailing address:
  • Phone: 719-253-7102
  • Fax: 719-253-7114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ANNETTE GARCIA
Title or Position: BUSINESS OFFICE MANAGER
Credential:
Phone: 719-253-7102