Healthcare Provider Details

I. General information

NPI: 1003505355
Provider Name (Legal Business Name): URBAN SPARK ELECTROLYSIS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6650 W 44TH AVE STE 2A
WHEAT RIDGE CO
80033-4711
US

IV. Provider business mailing address

9162 ALBION ST
THORNTON CO
80229-4128
US

V. Phone/Fax

Practice location:
  • Phone: 720-595-5060
  • Fax:
Mailing address:
  • Phone: 720-595-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEPHANI TARRAFERRO
Title or Position: ELECTROLYGIST/OWNER
Credential: P.E.
Phone: 720-595-5060