Healthcare Provider Details

I. General information

NPI: 1457465999
Provider Name (Legal Business Name): ANGELICA CARRANZA MUNGER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANGELICA CARRANZA MD

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 09/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 S COUNTY ROAD 5 SUITE 101
WINDSOR CO
80528-9002
US

IV. Provider business mailing address

8010 S COUNTY ROAD 5 SUITE 101
WINDSOR CO
80528-9002
US

V. Phone/Fax

Practice location:
  • Phone: 970-377-1300
  • Fax: 970-377-1314
Mailing address:
  • Phone: 970-377-1300
  • Fax: 970-377-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number40122
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number40122
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: