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General NPI Number Information
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NPI Number | 1356771802
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Entity Type | Organization
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Legal Business Name | MARY G HEYROSA MD LLC
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Dates
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Enumeration Date | 11/20/2013
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Last Update Date | 08/16/2021
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Provider Practice Location Address
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Address Line | 157 STEELE ST 1ST FLOOR
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City | DENVER
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State | CO
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Zip | 80206-8020
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Country | US
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Telephone | 720-575-9300
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Fax | 720-575-9566
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Provider Business Mailing Address
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Address Line | 757 E 20TH AVE STE 370 #444
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City | DENVER
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State | CO
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Zip | 80205-3278
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Country | US
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Telephone | 720-483-5690
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MARY GRACE HEYROSA
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Credential | MD
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Telephone | 720-483-5690
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | DR0044751
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License Number State | CO
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