Provider Demographics
NPI:1720652381
Name:RANGASWAMY, POONGUZHALI
Entity Type:Individual
Prefix:
First Name:POONGUZHALI
Middle Name:
Last Name:RANGASWAMY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11949 S SWIFT FOX WAY
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-3190
Mailing Address - Country:US
Mailing Address - Phone:720-257-1146
Mailing Address - Fax:
Practice Address - Street 1:4809 ARGONNE ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80249-6834
Practice Address - Country:US
Practice Address - Phone:303-649-3750
Practice Address - Fax:303-649-3751
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2022-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0996210363LF0000X
COAPN.0996210-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily