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General NPI Number Information
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NPI Number | 1770326472
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Entity Type | Organization
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Legal Business Name | FRONTERA MEDICAL PA
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Dates
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Enumeration Date | 06/18/2024
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Last Update Date | 08/25/2025
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Provider Practice Location Address
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Address Line | 1517 BLAKE ST STE 250
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City | DENVER
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State | CO
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Zip | 80202-5943
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Country | US
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Telephone | 785-410-8515
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 13096
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City | DENVER
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State | CO
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Zip | 80201-3296
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Country | US
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Telephone | 785-410-8515
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF BUSINESS DEVELOPMENT
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Name | NATE PHILLIPS
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Credential |
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Telephone | 785-410-8515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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