Provider Demographics
NPI:1043330608
Name:DECINO, DANIEL ANDREW (BA)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ANDREW
Last Name:DECINO
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 S PRATT PKWY
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6630
Mailing Address - Country:US
Mailing Address - Phone:970-535-4384
Mailing Address - Fax:
Practice Address - Street 1:1051 S PRATT PKWY
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-6630
Practice Address - Country:US
Practice Address - Phone:970-535-4384
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator