Provider Demographics
NPI:1083082507
Name:TRUONG, MIA KITAJIMA (NP)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:KITAJIMA
Last Name:TRUONG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MIA
Other - Middle Name:
Other - Last Name:KITAJIMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-490-4173
Practice Address - Street 1:175 S UNION BLVD STE 300
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80910-3126
Practice Address - Country:US
Practice Address - Phone:719-365-7630
Practice Address - Fax:719-365-7631
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0998129-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily