Provider Demographics
NPI:1073822664
Name:ARAGON, MARIO ANDRES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:ANDRES
Last Name:ARAGON
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9320 GRAND CORDERA PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7004
Mailing Address - Country:US
Mailing Address - Phone:719-282-6337
Mailing Address - Fax:719-282-0532
Practice Address - Street 1:9320 GRAND CORDERA PKWY
Practice Address - Street 2:STE 100
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7003
Practice Address - Country:US
Practice Address - Phone:719-282-6337
Practice Address - Fax:719-282-0532
Is Sole Proprietor?:No
Enumeration Date:2010-09-29
Last Update Date:2019-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003091363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant