Mario J Imola
Facial Plastic Surgeon
3600 S Logan St Suite 100
Englewood
, Colorado 80113-3766
Mario J Imola
Facial Plastic Surgeon
3600 S Logan St Suite 100
Englewood
, Colorado 80113-3766
(303) 839-7936
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About
Features
Specialties
- Facial Plastic Surgeon
Languages spoken
- English
Location
First Address
- Mario J Imola
- 3600 S Logan St Suite 100
- Englewood, CO
- Zip : 80113-3766
- Fax : (303) 839-7936
- Phone : (303) 839-7980
Second Address
- Mario J Imola
- 3600 S Logan St Suite 100
- Englewood, CO
- Zip : 80113-3766
- Fax : (303) 839-7936
- Phone : (303) 839-7980
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 207YS0123X | Facial Plastic Surgeon | 38335 | CO |
National Provider Identifier
| NPI | 1932101490 |
|---|---|
| Provider Name | Mario J Imola |
| First Address | Englewood, CO 80113-3766 |
| Second Address | Englewood, CO 80113-3766 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 15/08/2005 |
| Last Update Date | 17/10/2011 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 117142900 | (05) | WY |
| 841553144 | TAX ID (01) | CO |
| 95739831 | (05) | CO |
| G11247 | (02) | CO |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.