Healthcare Provider Details

I. General information

NPI: 1851237796
Provider Name (Legal Business Name): CAMILLE IRENE JACQUES HIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2026
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 WADSWORTH BLVD UNIT 3920
WHEAT RIDGE CO
80033-4615
US

IV. Provider business mailing address

3920 WADSWORTH BLVD UNIT 3920
WHEAT RIDGE CO
80033-4615
US

V. Phone/Fax

Practice location:
  • Phone: 303-953-5976
  • Fax: 303-424-0281
Mailing address:
  • Phone: 303-953-5976
  • Fax: 303-424-0281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD.0000616
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: