Healthcare Provider Details

I. General information

NPI: 1780806745
Provider Name (Legal Business Name): CLARA RAQUEL EPSTEIN MD, FICS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/29/2023
Certification Date: 11/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAIN ST
WESTCLIFFE CO
81252-9468
US

IV. Provider business mailing address

2121 CORRAL N
COTOPAXI CO
81223-8898
US

V. Phone/Fax

Practice location:
  • Phone: 303-800-9129
  • Fax: 720-638-0497
Mailing address:
  • Phone: 303-800-9129
  • Fax: 720-638-0497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA76471
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number40083
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: