Provider Demographics
NPI:1225514771
Name:ORRACA, JUAN M
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:M
Last Name:ORRACA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1017 S BIRCH ST APT 501B
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CO
Mailing Address - Zip Code:80246-2522
Mailing Address - Country:US
Mailing Address - Phone:720-787-2574
Mailing Address - Fax:
Practice Address - Street 1:1699 S COLORADO BLVD UNIT M
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80222-4021
Practice Address - Country:US
Practice Address - Phone:303-953-1471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0002229171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000OtherN/A