Healthcare Provider Details

I. General information

NPI: 1598017188
Provider Name (Legal Business Name): DALIFE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10431 TOWN CENTER DR STE 400
WESTMINSTER CO
80021-6076
US

IV. Provider business mailing address

10431 TOWN CENTER DR STE 400
WESTMINSTER CO
80021-6076
US

V. Phone/Fax

Practice location:
  • Phone: 303-955-8314
  • Fax: 303-993-4013
Mailing address:
  • Phone: 303-955-8314
  • Fax: 303-993-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code202K00000X
TaxonomyPhlebology Physician
License Number
License Number State

VIII. Authorized Official

Name: TRENT ALAN COPANAS
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 303-955-8314