Individual
TIRFESA EGU
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3332 VIERO DR, COLORADO SPRINGS, CO 80916-5738
(323) 636-5005
Mailing address
3332 VIERO DR, COLORADO SPRINGS, CO 80916-5738
(323) 636-5005
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
20201715299
CO
Other
Enumeration date
08/26/2020
Last updated
08/26/2020
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