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General NPI Number Information
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NPI Number | 1457305443
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Entity Type | Individual
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Provider Name | IMELDA SUELTO MD
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Gender | Female
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Dates
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Enumeration Date | 05/22/2006
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 2460 OAK HILLS DR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80919-3474
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Country | US
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Telephone | 719-661-9441
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 76510
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City | COLORADO SPRINGS
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State | CO
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Zip | 80970-6510
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Country | US
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Telephone | 719-663-8884
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Fax |
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME38870
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME38870
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License Number State | CO
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