Provider Demographics
NPI:1831713478
Name:PUCCIO, OLIVIA CHRISTINE (MD)
Entity type:Individual
Prefix:
First Name:OLIVIA
Middle Name:CHRISTINE
Last Name:PUCCIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2928 IOLA ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80238-3199
Mailing Address - Country:US
Mailing Address - Phone:328-603-5458
Mailing Address - Fax:
Practice Address - Street 1:9094 E MINERAL CIR STE 120
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80112-7201
Practice Address - Country:US
Practice Address - Phone:303-779-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-29
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0070948208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics