=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225514771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUAN M ORRACA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/18/2018
-----------------------------------------------------
Last Update Date | 07/18/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1699 S COLORADO BLVD UNIT M
-----------------------------------------------------
City | DENVER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80222-4021
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-953-1471
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1017 S BIRCH ST APT 501B
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80246-2522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 720-787-2574
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171100000X
-----------------------------------------------------
Taxonomy Name | Acupuncturist
-----------------------------------------------------
License Number | 0002229
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------