Provider Demographics
NPI:1992093686
Name:ONTIVEROS, RICHARD TED (CST, SA-C)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:TED
Last Name:ONTIVEROS
Suffix:
Gender:M
Credentials:CST, SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 WESTIN AVE
Mailing Address - Street 2:
Mailing Address - City:LOCHBUIE
Mailing Address - State:CO
Mailing Address - Zip Code:80603-5807
Mailing Address - Country:US
Mailing Address - Phone:303-564-1781
Mailing Address - Fax:
Practice Address - Street 1:1600 PRAIRIE CENTER PKWY
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:CO
Practice Address - Zip Code:80601-4006
Practice Address - Country:US
Practice Address - Phone:303-498-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-14
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZS0410X
CO15-719246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist