Provider Demographics
NPI:1508307091
Name:GIAMBRUNO, RICHARD
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:GIAMBRUNO
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 1:10940 S PARKER RD
Mailing Address - Street 2:#139
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-7440
Mailing Address - Country:US
Mailing Address - Phone:904-451-9488
Mailing Address - Fax:
Practice Address - Street 1:10940 S PARKER RD
Practice Address - Street 2:#139
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-7440
Practice Address - Country:US
Practice Address - Phone:904-451-9488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor