Provider Demographics
NPI:1205192705
Name:GASTA, MARGO (MARGARET) (MS, RD)
Entity Type:Individual
Prefix:MRS
First Name:MARGO (MARGARET)
Middle Name:
Last Name:GASTA
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 18834
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-1834
Mailing Address - Country:US
Mailing Address - Phone:303-885-1763
Mailing Address - Fax:866-412-0837
Practice Address - Street 1:737 29TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-2317
Practice Address - Country:US
Practice Address - Phone:303-885-1763
Practice Address - Fax:866-412-0837
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
727077133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered