1457034837 NPI number — MRS. IRRAH MARIE TARIMAN DICO MA

Table of content: KYLE O'CONNELL MD (NPI 1194514091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457034837 NPI number — MRS. IRRAH MARIE TARIMAN DICO MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICO
Provider First Name:
IRRAH MARIE
Provider Middle Name:
TARIMAN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TARIMAN
Provider Other First Name:
IRRAH MARIE
Provider Other Middle Name:
BUGHAO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1457034837
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/10/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2385 SAINT PAUL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80910-3204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-678-2011
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1060 HARRISON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80905-3586
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-579-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/10/2023

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: 235Z00000X , with the licence number:  SLP.0004873 , 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)





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