Provider Demographics
NPI:1063723690
Name:VILLALVAZO, KELSEY LEE
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:LEE
Last Name:VILLALVAZO
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 1:4732 S IDALIA ST
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80015-1711
Mailing Address - Country:US
Mailing Address - Phone:720-621-2540
Mailing Address - Fax:
Practice Address - Street 1:4732 S IDALIA ST
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80015-1711
Practice Address - Country:US
Practice Address - Phone:720-621-2540
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No385H00000XRespite Care FacilityRespite Care