Provider Demographics
NPI:1346775343
Name:5TH AVE FAMILY PRACTICE & COSMETICS PLLC
Entity Type:Organization
Organization Name:5TH AVE FAMILY PRACTICE & COSMETICS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:
Authorized Official - Last Name:OWUSU-FRIMPONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-360-7472
Mailing Address - Street 1:2044 CLINTON ST
Mailing Address - Street 2:UNIT B
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80010-1003
Mailing Address - Country:US
Mailing Address - Phone:303-360-7472
Mailing Address - Fax:
Practice Address - Street 1:2044 CLINTON ST
Practice Address - Street 2:UNIT B
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80010-1003
Practice Address - Country:US
Practice Address - Phone:303-360-7472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-27
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0057175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty