Provider Demographics
NPI:1194818666
Name:PIMENTEL, SACRAMENTO (MD)
Entity Type:Individual
Prefix:DR
First Name:SACRAMENTO
Middle Name:
Last Name:PIMENTEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 16TH ST.
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:CO
Mailing Address - Zip Code:80807-1649
Mailing Address - Country:US
Mailing Address - Phone:719-346-9481
Mailing Address - Fax:719-346-9485
Practice Address - Street 1:182 16TH ST.
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:CO
Practice Address - Zip Code:80807-1649
Practice Address - Country:US
Practice Address - Phone:719-346-9481
Practice Address - Fax:719-346-9485
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363654207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01363654Medicaid
CO248048Medicare ID - Type Unspecified
G62453Medicare UPIN