Healthcare Provider Details

I. General information

NPI: 1962888412
Provider Name (Legal Business Name): IESO DIGITAL HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2015
Last Update Date: 08/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 CENTERVILLE RD SUITE 400
WILMINGTON DE
19808-1660
US

IV. Provider business mailing address

2711 CENTERVILLE RD SUITE 400
WILMINGTON DE
19808-1660
US

V. Phone/Fax

Practice location:
  • Phone: 303-386-7142
  • Fax:
Mailing address:
  • Phone: 303-386-7142
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JULIAN COE
Title or Position: CHIEF OPERATIONS/FINANCIAL OFFICER
Credential:
Phone: 303-386-7142