MEDICARE: DALIFE LLC

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	261QM1300X	Multi-Specialty Clinic/Center
2	202K00000X	Phlebology Physician

General Provider Information

NPI Number	:	1598017188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DALIFE LLC

Provider Business Mailing Address
First Line	:	10431 TOWN CENTER DR STE 400
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-6076
Country	:	US
Telephone Number	:	303-955-8314
Fax Number	:	303-993-4013

Provider Business Practice Location Address
First Line	:	10431 TOWN CENTER DR STE 400
Second Line	:
City	:	WESTMINSTER
State	:	CO
Zip	:	80021-6076
Country	:	US
Telephone Number	:	303-955-8314
Fax Number	:	303-993-4013

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	TRENT ALAN COPANAS
Credential	:
Telephone Number	:	303-955-8314

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	03/17/2018

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Directions to “DALIFE LLC ” Practice Location

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