Provider Demographics
NPI:1164156527
Name:FUENTEALBA CARGILL, ANDREA ISABELLA (MD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:ISABELLA
Last Name:FUENTEALBA CARGILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:84 UINTA WAY APT 303
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230
Mailing Address - Country:US
Mailing Address - Phone:303-724-9245
Mailing Address - Fax:
Practice Address - Street 1:12631 EAST 17TH AVENUE, MS 8200
Practice Address - Street 2:ROOM 2414
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045
Practice Address - Country:US
Practice Address - Phone:303-724-9245
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COTL.00090462085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology