Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 51637 | CO |
NPI | 1003089293 |
---|---|
Provider Name | Kathleen Marie Rustici |
First Address | Aurora, CO 80045-2527 |
Second Address | Denver, CO 80238-2624 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2008 |
Last Update Date | 31/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
86270745 | (05) | CO |