Healthcare Provider Details

I. General information

NPI: 1619882537
Provider Name (Legal Business Name): CARLOS RUANO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

IV. Provider business mailing address

181 W MEADOW DR STE 400
VAIL CO
81657-5058
US

V. Phone/Fax

Practice location:
  • Phone: 970-680-0795
  • Fax: 970-479-5835
Mailing address:
  • Phone: 970-680-0795
  • Fax: 970-479-5835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: