Healthcare Provider Details

I. General information

NPI: 1306990874
Provider Name (Legal Business Name): RONALD JAMES ARCHULETA CST,CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 N GREENWOOD ST
PUEBLO CO
81003-3653
US

IV. Provider business mailing address

2711 N GREENWOOD ST
PUEBLO CO
81003-3653
US

V. Phone/Fax

Practice location:
  • Phone: 719-334-6474
  • Fax: 719-404-4174
Mailing address:
  • Phone: 719-334-6474
  • Fax: 719-404-4174

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: