Healthcare Provider Details

I. General information

NPI: 1043891195
Provider Name (Legal Business Name): JIGISHA HARESHBHAI RAKHOLIYA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2021
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1619 N GREENWOOD ST STE 402
PUEBLO CO
81003-2658
US

IV. Provider business mailing address

1619 N GREENWOOD ST STE 402
PUEBLO CO
81003-2658
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-2030
  • Fax: 719-562-2096
Mailing address:
  • Phone: 719-562-2030
  • Fax: 719-562-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberRS2024-0059
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberDR.0076664
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0008863
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: