Provider Demographics
NPI:1477160083
Name:SPANISH CLINIC LLC
Entity Type:Organization
Organization Name:SPANISH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-934-3040
Mailing Address - Street 1:4200 MORRISON RD UNIT 8
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2490
Mailing Address - Country:US
Mailing Address - Phone:720-225-7157
Mailing Address - Fax:
Practice Address - Street 1:12445 E 39TH AVE UNIT 207
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-3454
Practice Address - Country:US
Practice Address - Phone:720-335-6651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPANISH CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-09-28
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000162712Medicaid