Provider Demographics
NPI:1720085152
Name:MONDRAGON, PAULINE THERESE (PA)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:THERESE
Last Name:MONDRAGON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:PAULINE
Other - Middle Name:THERESE
Other - Last Name:KOCARNIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8015 W ALAMEDA AVE
Mailing Address - Street 2:STE 270
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80226-3041
Mailing Address - Country:US
Mailing Address - Phone:303-239-8327
Mailing Address - Fax:303-239-9946
Practice Address - Street 1:8015 W ALAMEDA AVE
Practice Address - Street 2:STE 270
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80226-3041
Practice Address - Country:US
Practice Address - Phone:303-239-8327
Practice Address - Fax:303-239-9946
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO193208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics