Healthcare Provider Details

I. General information

NPI: 1588598940
Provider Name (Legal Business Name): MINA ALLEGRA MARSCELLUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13630 QUEBEC ST
THORNTON CO
80602-8986
US

IV. Provider business mailing address

13630 QUEBEC ST
THORNTON CO
80602-8986
US

V. Phone/Fax

Practice location:
  • Phone: 303-593-9991
  • Fax: 303-854-6879
Mailing address:
  • Phone: 303-593-9991
  • Fax: 303-854-6879

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License NumberPHAT.0018258
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: