=====================================================
General NPI Number Information
=====================================================
NPI Number | 1609865427
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ARELIS BURGOS MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/14/2005
-----------------------------------------------------
Last Update Date | 07/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 905 W 124TH AVE STE 170
-----------------------------------------------------
City | WESTMINSTER
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80234-1716
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-442-6647
-----------------------------------------------------
Fax | 303-442-2696
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1056 S 88TH ST
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | CO
-----------------------------------------------------
Zip | 80027-9460
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 303-442-6647
-----------------------------------------------------
Fax | 303-442-2696
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207NP0225X
-----------------------------------------------------
Taxonomy Name | Pediatric Dermatology Physician
-----------------------------------------------------
License Number | ME143043
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | 44721
-----------------------------------------------------
License Number State | CO
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207N00000X
-----------------------------------------------------
Taxonomy Name | Dermatology Physician
-----------------------------------------------------
License Number | ME143043
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------