Individual
UFAQ ISHTIAQ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1600 N GRAND AVE STE 140, PUEBLO, CO 81003-2755
(719) 564-1542
(719) 544-2741
Mailing address
400 W 16TH ST, PUEBLO, CO 81003-2745
(719) 584-4000
(719) 544-2741
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
DR.0072460
CO
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/30/2021
Last updated
08/05/2024
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