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General NPI Number Information
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NPI Number | 1770714339
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Entity Type | Organization
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Legal Business Name | OPTUMCARE COLORADO MEDICAL GROUP LLC
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Dates
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Enumeration Date | 07/30/2009
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Last Update Date | 08/20/2024
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Provider Practice Location Address
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Address Line | 1625 MEDICAL CENTER PT STE 210
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City | COLORADO SPRINGS
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State | CO
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Zip | 80907-5798
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Country | US
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Telephone | 719-635-5803
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Fax | 719-448-0164
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Provider Business Mailing Address
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Address Line | PO BOX 35380
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City | LAS VEGAS
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State | NV
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Zip | 89133-5380
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Country | US
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Telephone | 702-579-3203
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Fax | 719-538-2990
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Authorized Official
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Title or Position | ASSOCIATE DIRECTOR CREDENTIALING
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Name | EMILY CASTILLO
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Credential |
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Telephone | 702-579-3253
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207RS0012X
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Taxonomy Name | Sleep Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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