Provider Demographics
NPI:1073221693
Name:BELEN, DOMINGO FAJARDO
Entity Type:Individual
Prefix:
First Name:DOMINGO
Middle Name:FAJARDO
Last Name:BELEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 460832
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80246-0832
Mailing Address - Country:US
Mailing Address - Phone:720-651-7288
Mailing Address - Fax:
Practice Address - Street 1:612 E 9TH AVE # USA
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203-3318
Practice Address - Country:US
Practice Address - Phone:720-651-7288
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker