Organization
SOUTHERN COLORADO DERMATOLOGY CLINIC PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRYSTAL JEAN NAKAMURA MD (OWNER)
(719) 564-5544
Entity
Organization
Contact information
Practice address
900 INDIANA AVE STE C, PUEBLO, CO 81004-3767
(719) 564-5544
(719) 564-2246
Mailing address
900 INDIANA AVE STE C, PUEBLO, CO 81004-3767
(719) 564-5544
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
44146
CO
Other
Enumeration date
02/05/2009
Last updated
05/25/2021
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