| Carl A Mortiz Jr Mbr | |
|
2760 29th St Ste 2b Boulder CO 80301-1221 | |
| (303) 444-6400 | |
| (303) 444-6465 |
| Full Name | Carl A Mortiz Jr Mbr |
|---|---|
| Speciality | Family Medicine |
| Location | 2760 29th St Ste 2b, Boulder, Colorado |
| Authorized Official Name and Position | Lauren Jasilli (PRACTICE OWNER) |
| Authorized Official Contact | 3034446400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Carl A Mortiz Jr Mbr 2760 29th St Ste 2b Boulder CO 80301-1221 Ph: (303) 444-6400 | Carl A Mortiz Jr Mbr 2760 29th St Ste 2b Boulder CO 80301-1221 Ph: (303) 444-6400 |
| NPI Number | 1164048161 |
|---|---|
| Provider Enumeration Date | 06/25/2020 |
| Last Update Date | 09/27/2024 |
| Medicare PECOS PAC ID | 1557716016 |
|---|---|
| Medicare Enrollment ID | O20231018002955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164048161 | NPI | - | NPPES |
| 0126399 | Medicaid | CO |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Carl Albert Moritz |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538128434 PECOS PAC ID: 0143232520 Enrollment ID: I20060629000355 |
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