Organization
PUEBLO SPORTS AND FAMILY MEDICINE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. RAKESH KHOSLA MD (PRESIDENT)
(719) 544-2740
Entity
Organization
Contact information
Practice address
1315 FORTINO BLVD STE C, PUEBLO, CO 81008-1981
(719) 544-2740
Mailing address
1315 FORTINO BLVD STE C, PUEBLO, CO 81008-1981
(719) 544-2740
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
543004
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0004910
PA NUMBER
CO
05
—
1268788
—
CO
Enumeration date
04/16/2018
Last updated
04/22/2018
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