Provider Demographics
NPI:1952800187
Name:COLORADO FAMILY CLINIC
Entity Type:Organization
Organization Name:COLORADO FAMILY CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:VALENTIN
Authorized Official - Last Name:SOLANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-456-4882
Mailing Address - Street 1:4990 KIPLING ST STE B6
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-6762
Mailing Address - Country:US
Mailing Address - Phone:303-456-4882
Mailing Address - Fax:303-456-4875
Practice Address - Street 1:4990 KIPLING ST STE B6
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-6762
Practice Address - Country:US
Practice Address - Phone:303-456-4882
Practice Address - Fax:303-456-4875
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-02
Last Update Date:2018-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO3083207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty