Provider Demographics
NPI:1861740532
Name:KURINETS, MARGARITA (PA-C)
Entity type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:KURINETS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5450 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2709
Mailing Address - Country:US
Mailing Address - Phone:303-415-7599
Mailing Address - Fax:303-530-5474
Practice Address - Street 1:1100 BALSAM AVE
Practice Address - Street 2:3W
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3404
Practice Address - Country:US
Practice Address - Phone:303-415-4858
Practice Address - Fax:303-415-4057
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2017-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003484363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO19570520Medicaid
CO19570520Medicaid