Basic Information
| Provider Information | |||||||||
| NPI: | 1134446461 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARDONES | ||||||||
| FirstName: | MABEL | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10107 RIDGEGATE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801245641 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039250700 | ||||||||
| FaxNumber: | 3033292599 | ||||||||
| Practice Location | |||||||||
| Address1: | 10107 RIDGEGATE PKWY STE 200 | ||||||||
| Address2: | |||||||||
| City: | LONE TREE | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80124 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039250700 | ||||||||
| FaxNumber: | 3033292599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2010 | ||||||||
| LastUpdateDate: | 09/05/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | P8274 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RH0003X | P8274 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RH0003X | DR0060709 | CO | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 9000165257 | 05 | CO | MEDICAID | 333672901 | 05 | TX | MEDICAID | 333672902 | 05 | TX | MEDICAID | P01800849 | 01 | TX | RAILROAD | OTHER |