Provider Demographics
NPI:1922985175
Name:PUEBLO CARE UT LLC
Entity type:Organization
Organization Name:PUEBLO CARE UT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:ANGLADA CORTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-761-1362
Mailing Address - Street 1:PO BOX 6006
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80021-0001
Mailing Address - Country:US
Mailing Address - Phone:720-761-1362
Mailing Address - Fax:
Practice Address - Street 1:1289 DEER PARK CIR UNIT 304
Practice Address - Street 2:
Practice Address - City:HEBER CITY
Practice Address - State:UT
Practice Address - Zip Code:84032-1255
Practice Address - Country:US
Practice Address - Phone:720-761-1362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty