Provider Demographics
NPI:1851411409
Name:OLIVEIRA, RENATA PRADO DE FUCCIO (MD)
Entity Type:Individual
Prefix:DR
First Name:RENATA
Middle Name:PRADO DE FUCCIO
Last Name:OLIVEIRA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9348 GRAND CORDERA PKWY
Mailing Address - Street 2:SUITE 160
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80924-7023
Mailing Address - Country:US
Mailing Address - Phone:719-355-1585
Mailing Address - Fax:719-623-2983
Practice Address - Street 1:9348 GRAND CORDERA PKWY
Practice Address - Street 2:SUITE 160
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80924-7023
Practice Address - Country:US
Practice Address - Phone:719-355-1585
Practice Address - Fax:719-623-2983
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR.0050098207N00000X, 207NS0135X, 207ND0101X
MA250766207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology