Provider Demographics
NPI:1073842191
Name:TERINONI, GINA ROSELLA (LAC)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:ROSELLA
Last Name:TERINONI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5370 MANHATTAN CIR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-4250
Mailing Address - Country:US
Mailing Address - Phone:303-242-7272
Mailing Address - Fax:
Practice Address - Street 1:5370 MANHATTAN CIR
Practice Address - Street 2:SUITE 105
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-4250
Practice Address - Country:US
Practice Address - Phone:303-242-7272
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-19
Last Update Date:2009-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1193171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist