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General NPI Number Information
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NPI Number | 1184775959
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Entity Type | Organization
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Legal Business Name | CLINICA CAMPESINA FAMILY HEALTH SERVICES
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Dates
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Enumeration Date | 01/16/2007
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Last Update Date | 01/30/2019
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Provider Practice Location Address
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Address Line | 1701 W 72ND AVE 1ST FLOOR
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City | DENVER
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State | CO
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Zip | 80221-2721
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Country | US
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Telephone | 720-207-0150
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Fax | 303-650-2557
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Provider Business Mailing Address
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Address Line | 1735 S PUBLIC RD STE 203
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City | LAFAYETTE
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State | CO
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Zip | 80026-7093
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Country | US
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Telephone | 303-665-3036
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. SIMON SMITH
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Credential |
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Telephone | 303-665-3036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number | 535
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License Number State | CO
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