Provider Demographics
NPI:1174750491
Name:IRENE, LUIS ERNESTO II
Entity type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ERNESTO
Last Name:IRENE
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10365 JULIAN CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6706
Mailing Address - Country:US
Mailing Address - Phone:720-350-3040
Mailing Address - Fax:
Practice Address - Street 1:10365 JULIAN CT
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-6706
Practice Address - Country:US
Practice Address - Phone:720-350-3040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-12
Last Update Date:2009-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMT-555225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist