Provider Demographics
NPI:1578689196
Name:MINDORO, SUSAN L (MPH,RD,CDCES)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:MINDORO
Suffix:
Gender:F
Credentials:MPH,RD,CDCES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15389 W 91ST DR STE 200
Mailing Address - Street 2:
Mailing Address - City:ARVADA
Mailing Address - State:CO
Mailing Address - Zip Code:80007-1406
Mailing Address - Country:US
Mailing Address - Phone:303-403-7930
Mailing Address - Fax:303-425-2792
Practice Address - Street 1:10065 E HARVARD AVE
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80231-5968
Practice Address - Country:US
Practice Address - Phone:303-338-4545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO813764133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
011213OtherKAISER-COMMERCIAL NUMBER