Basic Information
| Provider Information | |||||||||
| NPI: | 1689381675 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | AGUDELO | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | CAMILO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7887 E BELLEVIEW AVE | ||||||||
| Address2: | STE 500 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801116077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7887 E BELLEVIEW AVE | ||||||||
| Address2: | STE 500 | ||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 801116077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202873093 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/31/2022 | ||||||||
| LastUpdateDate: | 10/31/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/31/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 246ZE0600X | Y | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Electroneurodiagnostic |
No ID Information.