Provider Demographics
NPI:1184853160
Name:PARRA, CHANELL RAMONA (RDH)
Entity Type:Individual
Prefix:MS
First Name:CHANELL
Middle Name:RAMONA
Last Name:PARRA
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4147 OUTLOOK BLVD
Mailing Address - Street 2:UNIT Q
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81008-2623
Mailing Address - Country:US
Mailing Address - Phone:719-240-3678
Mailing Address - Fax:
Practice Address - Street 1:4147 OUTLOOK BLVD
Practice Address - Street 2:UNIT Q
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-2623
Practice Address - Country:US
Practice Address - Phone:719-240-3678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO905711124Q00000X
CO1050715224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
No224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant