Provider Demographics
NPI:1053830927
Name:DELGADO, CARLA NOHEMI (LMT)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:NOHEMI
Last Name:DELGADO
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1534 BALSAM CT
Mailing Address - Street 2:
Mailing Address - City:RIFLE
Mailing Address - State:CO
Mailing Address - Zip Code:81650-3659
Mailing Address - Country:US
Mailing Address - Phone:970-618-5820
Mailing Address - Fax:
Practice Address - Street 1:726 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-3552
Practice Address - Country:US
Practice Address - Phone:970-625-1129
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2017-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0005993225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty