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General NPI Number Information
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NPI Number | 1245716091
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Entity Type | Individual
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Provider Name | PEDRO FELIX DIAZ RAMOS LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 09/08/2020
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Provider Practice Location Address
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Address Line | 1635 BLUE SPRUCE DR
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City | FORT COLLINS
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State | CO
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Zip | 80524-5427
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Country | US
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Telephone | 970-494-4040
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Fax | 970-494-4050
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Provider Business Mailing Address
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Address Line | 203 S ROLLIE AVE
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City | FORT LUPTON
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State | CO
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Zip | 80621-1508
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Country | US
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Telephone | 303-892-6401
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Fax | 303-892-1511
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | CSW.09925891
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License Number State | CO
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