1992332795 NPI number — KIMBERLY E DIMANNA DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992332795 NPI number — KIMBERLY E DIMANNA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DIMANNA
Provider First Name:
KIMBERLY
Provider Middle Name:
E
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1992332795
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10099 RIDGEGATE PKWY STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
720-795-9733
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 E HAMPDEN AVE STE 360
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:
80113-3877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-781-4485
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2020

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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