Healthcare Provider Details

I. General information

NPI: 1932708872
Provider Name (Legal Business Name): CARLA E PAREDES DIAZ FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3676 PARKER BLVD
PUEBLO CO
81008-2212
US

IV. Provider business mailing address

2215 SOUTH DR
PUEBLO CO
81008-1755
US

V. Phone/Fax

Practice location:
  • Phone: 719-553-2201
  • Fax: 833-916-2047
Mailing address:
  • Phone: 719-369-9987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0996203-NP
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: