Provider Demographics
NPI:1962523555
Name:MELENDEZ, ELISA GUARDIOLA (MD)
Entity type:Individual
Prefix:
First Name:ELISA
Middle Name:GUARDIOLA
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5075 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80216-2015
Mailing Address - Country:US
Mailing Address - Phone:303-458-5302
Mailing Address - Fax:303-433-7452
Practice Address - Street 1:1181 E. 120TH AVE, UNIT A
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80233
Practice Address - Country:US
Practice Address - Phone:303-673-1500
Practice Address - Fax:303-689-6664
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46156207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO03929001Medicaid
COC810866Medicare PIN