Healthcare Provider Details

I. General information

NPI: 1609865427
Provider Name (Legal Business Name): ARELIS BURGOS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/26/2024
Certification Date: 07/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 W 124TH AVE STE 170
WESTMINSTER CO
80234-1716
US

IV. Provider business mailing address

1056 S 88TH ST
LOUISVILLE CO
80027-9460
US

V. Phone/Fax

Practice location:
  • Phone: 303-442-6647
  • Fax: 303-442-2696
Mailing address:
  • Phone: 303-442-6647
  • Fax: 303-442-2696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207NP0225X
TaxonomyPediatric Dermatology Physician
License NumberME143043
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number44721
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberME143043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: