1437456746 NPI number — LYDIA CAMIELL GAREY PN-25642, ACC-6941

Table of content: LYDIA CAMIELL GAREY PN-25642, ACC-6941 (NPI 1437456746)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437456746 NPI number — LYDIA CAMIELL GAREY PN-25642, ACC-6941

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GAREY
Provider First Name:
LYDIA
Provider Middle Name:
CAMIELL
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PN-25642, ACC-6941
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:
1437456746
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14005 E 54TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80239-4109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-204-3293
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1620 GAYLORD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80206-1207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-388-5894
Provider Business Practice Location Address Fax Number:
303-336-1601
Provider Enumeration Date:
02/23/2011

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: 101YA0400X , with the licence number:  ACC-6941 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 164W00000X , with the licence number: PN-25642 , 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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