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General NPI Number Information
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NPI Number | 1114189446
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Entity Type | Organization
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Legal Business Name | AXIS INCORPORATED LLC
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 02/19/2015
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Provider Practice Location Address
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Address Line | 1816 SEA SHELL CT
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City | WINDSOR
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State | CO
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Zip | 80550
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Country | US
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Telephone | 970-818-6190
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Fax | 970-460-0581
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Provider Business Mailing Address
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Address Line | 1816 SEA SHELL CT
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City | WINDSOR
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State | CO
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Zip | 80550
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Country | US
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Telephone | 970-818-6190
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Fax | 970-460-0581
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MRS. MAROMI DHUPAR-SAKURAI
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Credential |
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Telephone | 970-818-6190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1512
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License Number State | CO
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Taxonomy #3
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Taxonomy Code | 246ZE0600X
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Taxonomy Name | Electroneurodiagnostic Specialist/Technologist
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License Number |
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License Number State |
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