1487713541 NPI number — KRISTALAINE GALATAS P.A.

Table of content: KRISTALAINE GALATAS P.A. (NPI 1487713541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487713541 NPI number — KRISTALAINE GALATAS P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GALATAS
Provider First Name:
KRISTALAINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487713541
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ENGLEWOOD
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80151-0060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-493-5200
Provider Business Mailing Address Fax Number:
720-570-2012

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
799 E HAMPDEN AVE STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-788-6490
Provider Business Practice Location Address Fax Number:
303-788-5451
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  2306 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 36403865 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 020835 . This is a "KAISER COMMERCIAL NUMBER" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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