Provider Demographics
NPI:1285789230
Name:RICHMOND-COCA, BLANCA (MD)
Entity type:Individual
Prefix:DR
First Name:BLANCA
Middle Name:
Last Name:RICHMOND-COCA
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 1:1606 PRAIRIE CENTER PKWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:BRIGHTON
Mailing Address - State:CO
Mailing Address - Zip Code:80601-4004
Mailing Address - Country:US
Mailing Address - Phone:303-659-1152
Mailing Address - Fax:720-685-0027
Practice Address - Street 1:1606 PRAIRIE CENTER PKWY
Practice Address - Street 2:SUITE 240
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4004
Practice Address - Country:US
Practice Address - Phone:303-659-1152
Practice Address - Fax:720-685-0027
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37518207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO487208Medicare PIN
COH07576Medicare UPIN
CO37518Medicare ID - Type Unspecified