Healthcare Provider Details

I. General information

NPI: 1366417966
Provider Name (Legal Business Name): MARILU OROZCO-PETERSON M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 06/12/2020
Certification Date: 06/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SIGNAL TREE DR STE 1200
TIMNATH CO
80547-4908
US

IV. Provider business mailing address

4650 SIGNAL TREE DR STE 1200
TIMNATH CO
80547-4908
US

V. Phone/Fax

Practice location:
  • Phone: 970-237-7415
  • Fax: 970-237-7420
Mailing address:
  • Phone: 970-237-7415
  • Fax: 970-237-7420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10408A
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0036358
License Number StateCO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier50773241
Identifier TypeMEDICAID
Identifier StateCO
Identifier Issuer
# 2
Identifier659946
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerBLUE CROSS
# 3
Identifier7173241
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerAETNA
# 4
IdentifierP000048149
Identifier TypeOTHER
Identifier StateCO
Identifier IssuerMEDICARE RAILROAD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: