=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346287141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEONARD LOSASSO MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/01/2006
-----------------------------------------------------
Last Update Date | 09/24/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1421 S POTOMAC ST STE 240
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80012-4512
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-695-2822
-----------------------------------------------------
Fax | 303-368-2036
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1411 S POTOMAC ST STE 230
-----------------------------------------------------
City | AURORA
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80012-4525
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-353-9531
-----------------------------------------------------
Fax | 303-745-7987
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207V00000X
-----------------------------------------------------
Taxonomy Name | Obstetrics & Gynecology Physician
-----------------------------------------------------
License Number | 20360
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------