Boulder Valley Center for Dermatology LLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

BOULDER VALLEY CENTER FOR DERMATOLOGY LLC

Practice address

1610 Prairie Center Pkwy Ste 2230
Brighton, CO 80601-4008

Phone

(303) 604-1444

Fax

(303) 666-0911

NPI assigned

Dec 7, 2020

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Kenyon

Title

Practice Admin

Phone

(720) 308-7714

Specialties & licenses 1

Addresses

Tax ID family

Boulder Valley Center for Dermatolo2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Boulder Valley Center for Dermatology LLC

  • Dermatology Physician
  • Boulder, CO
  • NPI 1063018000
  NPD tax ID

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725321600000",
    "number": "1972109916",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 272308",
            "city": "FORT COLLINS",
            "state": "CO",
            "postal_code": "805272308",
            "telephone_number": "303-604-1444",
            "fax_number": "970-484-2251"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1610 PRAIRIE CENTER PKWY STE 2230",
            "city": "BRIGHTON",
            "state": "CO",
            "postal_code": "806014008",
            "telephone_number": "303-604-1444",
            "fax_number": "303-666-0911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BOULDER VALLEY CENTER FOR DERMATOLOGY LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-07",
        "last_updated": "2024-09-03",
        "certification_date": "2024-09-03",
        "status": "A",
        "authorized_official_last_name": "KENYON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_title_or_position": "PRACTICE ADMIN",
        "authorized_official_telephone_number": "720-308-7714"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jessica Lynn Brangoccio, MA. LPC
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• Dermatology Physician in Brighton, CO
• Providers in Brighton, CO by specialty
• Dermatology Physician in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 3, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.