Provider Demographics
NPI:1982081758
Name:KROCHTA, DELLA (MAOTR)
Entity Type:Individual
Prefix:
First Name:DELLA
Middle Name:
Last Name:KROCHTA
Suffix:
Gender:F
Credentials:MAOTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6895 S STEELE ST
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-1838
Mailing Address - Country:US
Mailing Address - Phone:303-949-1017
Mailing Address - Fax:
Practice Address - Street 1:6895 S STEELE ST
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-1838
Practice Address - Country:US
Practice Address - Phone:303-949-1017
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000910172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker