Provider Demographics
NPI:1720689789
Name:NOCO NEW BEGINNINGS
Entity type:Organization
Organization Name:NOCO NEW BEGINNINGS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:VASQUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, PMHNP-BC
Authorized Official - Phone:970-978-1160
Mailing Address - Street 1:1019 39TH AVE STE J
Mailing Address - Street 2:
Mailing Address - City:GREELEY
Mailing Address - State:CO
Mailing Address - Zip Code:80634-2501
Mailing Address - Country:US
Mailing Address - Phone:970-909-2035
Mailing Address - Fax:970-909-2068
Practice Address - Street 1:1019 39TH AVE STE J
Practice Address - Street 2:
Practice Address - City:GREELEY
Practice Address - State:CO
Practice Address - Zip Code:80634-2501
Practice Address - Country:US
Practice Address - Phone:970-909-2035
Practice Address - Fax:970-909-2068
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO91002761Medicaid