INTEGRATED DERMATOLOGY OF BOULDER CREEK, LLC
NPI 1568033066
Dermatology in Superior, CO

Active since July 06, 2021
400 S MCCASLIN BLVD STE 100, SUPERIOR, CO 80027(303) 666-5261(303) 604-6062 Get Directions Write a Review

NPPES record last updated: July 6, 2021. Verified against the NPPES registry weekly; last sync: August 16, 2026.

About Integrated Dermatology Of Boulder Creek, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

INTEGRATED DERMATOLOGY OF BOULDER CREEK, LLC (NPI 1568033066) is a healthcare organization registered as a dermatology in Superior, Colorado and active in the NPI registry since July 2021. The organization lists David Fuentes, Authorized, as its authorized official.

NPPES Registry Identity

NPI1568033066
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameINTEGRATED DERMATOLOGY OF BOULDER CREEK, LLC
Location Address400 S MCCASLIN BLVD STE 100Superior, CO 80027-9701
Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 431-2821
Fax(303) 604-6062
Organization SubpartNo
Authorized OfficialDavid FuentesAuthorized · (561) 314-2000
Enumeration DateJuly 6, 2021
NPPES CertifiedJuly 6, 2021
NPI 1568033066 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 3

Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
Also ListedPhysician AssistantTaxonomy 363A00000X
400 S MCCASLIN BLVD STE 100, Superior, CO 80027

Other Identifiers 1

Medicaid9000168857CO

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 06D1024694

Integrated Dermatology Of Boulder Creek, PLLC · Louisville, CO
Expired · Jul 31, 2026
CLIA Number06D1024694
Laboratory TypePhysician Office
Certificate Effective DateMay 20, 2024
Certificate Expiration DateJuly 31, 2026
Laboratory DirectorDr. Todd C. Becker
Laboratory Phone(303) 666-5261
Laboratory LocationIntegrated Dermatology Of Boulder Creek, PLLC400 S Mccaslin Blvd, Suite 100, Louisville, CO 80027
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Integrated Dermatology Of Boulder Creek, LLC's NPI number?

The NPI number for Integrated Dermatology Of Boulder Creek, LLC is 1568033066. It was assigned to this organization in the NPPES registry on July 6, 2021.

Where is Integrated Dermatology Of Boulder Creek, LLC located?

Integrated Dermatology Of Boulder Creek, LLC is located at 400 S Mccaslin Blvd Ste 100, Superior, CO 80027. The listed phone number is (303) 666-5261.

What is Integrated Dermatology Of Boulder Creek, LLC's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

When was this NPI record last updated?

The NPPES record for Integrated Dermatology Of Boulder Creek, LLC was last updated on July 6, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.