MEDICARE: JUANA ARROYO SOTO CAC II

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	ACB.0008262	CO

General Provider Information

NPI Number	:	1538673157
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANA ARROYO SOTO CAC II

Provider Business Mailing Address
First Line	:	15466 CAROLINE AVE
Second Line	:
City	:	FORT LUPTON
State	:	CO
Zip	:	80621-4202
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2370 W ALAMEDA AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80223-1991
Country	:	US
Telephone Number	:	303-477-8280
Fax Number	:	303-477-8280

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/17/2017
Last Update Date	:	11/28/2017

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