Healthcare Provider Details

I. General information

NPI: 1952800187
Provider Name (Legal Business Name): COLORADO FAMILY CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2018
Last Update Date: 02/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 KIPLING ST STE B6
WHEAT RIDGE CO
80033-6762
US

IV. Provider business mailing address

4990 KIPLING ST STE B6
WHEAT RIDGE CO
80033-6762
US

V. Phone/Fax

Practice location:
  • Phone: 303-456-4882
  • Fax: 303-456-4875
Mailing address:
  • Phone: 303-456-4882
  • Fax: 303-456-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberCO3083
License Number StateCO

VIII. Authorized Official

Name: ANDREW VALENTIN SOLANO
Title or Position: OWNER
Credential:
Phone: 303-456-4882