Provider Demographics
NPI:1598012064
Name:SPANISH CLINIC LLC
Entity type:Organization
Organization Name:SPANISH CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALFONSO
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CAC III
Authorized Official - Phone:303-934-3040
Mailing Address - Street 1:4200 MORRISON RD
Mailing Address - Street 2:UNIT 8
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80219-2481
Mailing Address - Country:US
Mailing Address - Phone:303-934-3040
Mailing Address - Fax:303-934-4188
Practice Address - Street 1:4200 MORRISON RD
Practice Address - Street 2:UNIT 8
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80219-2481
Practice Address - Country:US
Practice Address - Phone:303-934-3040
Practice Address - Fax:303-934-4188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO4790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO82986541Medicaid