1063075729 NPI number — AKUA TINA ABRAFI RDH

Table of content: AKUA TINA ABRAFI RDH (NPI 1063075729)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063075729 NPI number — AKUA TINA ABRAFI RDH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ABRAFI
Provider First Name:
AKUA
Provider Middle Name:
TINA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDH
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:
1063075729
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/12/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3701 S BROADWAY
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:
80113-3611
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-360-6276
Provider Business Mailing Address Fax Number:
303-761-2787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
STRIDE CHC - NORTH AURORA FAMILY HEALTH SERVICES
Provider Second Line Business Practice Location Address:
3292 PEORIA STREET
Provider Business Practice Location Address City Name:
AURORA
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80010-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-360-6276
Provider Business Practice Location Address Fax Number:
303-343-7290
Provider Enumeration Date:
04/18/2019

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: 124Q00000X , with the licence number:  DH.002024763 , 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)