Healthcare Provider Details

I. General information

NPI: 1962523555
Provider Name (Legal Business Name): ELISA GUARDIOLA MELENDEZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 10/11/2023
Certification Date: 10/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1181 E. 120TH AVE, UNIT A
THORNTON CO
80233
US

IV. Provider business mailing address

5075 LINCOLN ST
DENVER CO
80216-2015
US

V. Phone/Fax

Practice location:
  • Phone: 303-673-1500
  • Fax: 303-689-6664
Mailing address:
  • Phone: 303-458-5302
  • Fax: 303-433-7452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number46156
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: