Provider Demographics
NPI:1245579010
Name:BLANCA RICHMOND-COCA MD PC
Entity Type:Organization
Organization Name:BLANCA RICHMOND-COCA MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLANCA
Authorized Official - Middle Name:E
Authorized Official - Last Name:RICHMOND COCA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-659-1152
Mailing Address - Street 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:STE 240
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-659-1152
Mailing Address - Fax:720-685-0027
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:STE 240
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-659-1152
Practice Address - Fax:720-685-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-13
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty