Provider Demographics
NPI:1073986980
Name:PASSAFARO, RACHAEL
Entity Type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:PASSAFARO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 N PENNSYLVANIA ST
Mailing Address - Street 2:APT 303
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80203-1396
Mailing Address - Country:US
Mailing Address - Phone:703-408-1486
Mailing Address - Fax:
Practice Address - Street 1:755 HERITAGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-3600
Practice Address - Country:US
Practice Address - Phone:303-277-0700
Practice Address - Fax:303-277-0714
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-02
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0004546363AM0700X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003172003AMedicaid
FL016102900Medicaid
FLIK322ZMedicare PIN