Provider Demographics
NPI:1578642922
Name:CONSULTANTS IN NEPHROLOGY AND HYPERTENSION PROFESSIONAL LLC
Entity type:Organization
Organization Name:CONSULTANTS IN NEPHROLOGY AND HYPERTENSION PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:OSCAR
Authorized Official - Middle Name:G
Authorized Official - Last Name:DOMINGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-697-1636
Mailing Address - Street 1:PO BOX 4940
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-0940
Mailing Address - Country:US
Mailing Address - Phone:303-697-1636
Mailing Address - Fax:303-805-9948
Practice Address - Street 1:9397 CROWN CREST BLVD STE 401
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80138-8789
Practice Address - Country:US
Practice Address - Phone:303-697-1636
Practice Address - Fax:303-805-9948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2018-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO37995207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO42289319Medicaid
COH07142Medicare UPIN
CO42289319Medicaid