Healthcare Provider Details

I. General information

NPI: 1407940257
Provider Name (Legal Business Name): DALILA RENEE WHITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 COURT ST
PUEBLO CO
81003-2715
US

IV. Provider business mailing address

2695 ROCKY MOUNTAIN AVE
LOVELAND CO
80538-8702
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-2300
  • Fax: 719-562-2095
Mailing address:
  • Phone: 970-624-2403
  • Fax: 970-490-4173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberDR.0076437
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: