Provider Demographics
NPI:1407960495
Name:GIACHINO, STEFANIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:L
Last Name:GIACHINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:STEFANIE
Other - Middle Name:
Other - Last Name:BUHELOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:10350 E DAKOTA AVE
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80247-1314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10168 PARKGLENN WAY
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-3868
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2021-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2253363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86804049Medicaid
CO023581OtherKAISER COMMERCIAL NUMBER
CO2253OtherLICENSE
COQ72149Medicare UPIN
CO86804049Medicaid