Organization
SC TELEHEALTH CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RENEE D FASANO (OWNER MANAGER)
(719) 582-7287
Entity
Organization
Contact information
Practice address
1013 CANDYTUFT BLVD, PUEBLO, CO 81001-1026
(719) 582-7287
Mailing address
1013 CANDYTUFT BLVD, PUEBLO, CO 81001-1026
(719) 582-7287
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Enumeration date
01/16/2020
Last updated
01/16/2020
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