Healthcare Provider Details

I. General information

NPI: 1447282603
Provider Name (Legal Business Name): KORINA R BERSENTES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 03/07/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

936 SHAVANO PEAK DR
SUPERIOR CO
80027-6084
US

IV. Provider business mailing address

936 SHAVANO PEAK DR
SUPERIOR CO
80027-6084
US

V. Phone/Fax

Practice location:
  • Phone: 303-912-8948
  • Fax: 303-494-5264
Mailing address:
  • Phone: 303-912-8948
  • Fax: 303-494-5264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number36175
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: