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NPI Code Detail

MEDICARE: DR. RENATA PRADO DE FUCCIO OLIVEIRA M.D.

MEDICARE: DR. RENATA PRADO DE FUCCIO OLIVEIRA M.D.
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
1207N00000XDermatology PhysicianDR.0050098CO
2207ND0101XMOHS-Micrographic Surgery Physician250766MA
3207NS0135XProcedural Dermatology PhysicianDR.0050098CO
4207ND0101XMOHS-Micrographic Surgery PhysicianDR.0050098CO

General Provider Information

NPI Number : 1851411409
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RENATA PRADO DE FUCCIO OLIVEIRA M.D.
Provider Business Mailing Address
First Line : 9348 GRAND CORDERA PKWY
Second Line : SUITE 160
City : COLORADO SPRINGS
State : CO
Zip : 80924-7023
Country : US
Telephone Number : 719-355-1585
Fax Number : 719-623-2983
Provider Business Practice Location Address
First Line : 9348 GRAND CORDERA PKWY
Second Line : SUITE 160
City : COLORADO SPRINGS
State : CO
Zip : 80924-7023
Country : US
Telephone Number : 719-355-1585
Fax Number : 719-623-2983
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2007
Last Update Date : 11/04/2020

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