Provider Demographics
NPI:1609040773
Name:SPANISH CLINIC
Entity Type:Organization
Organization Name:SPANISH CLINIC
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:720-225-7157
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
Mailing Address - Country:US
Mailing Address - Phone:303-934-3040
Mailing Address - Fax:303-934-4188
Practice Address - Street 1:4200 MORRISON RD, UNIT 8
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219
Practice Address - Country:US
Practice Address - Phone:303-934-3040
Practice Address - Fax:303-934-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2020-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6635251300000X, 251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
No251B00000XAgenciesCase Management
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO6635OtherCAC III