Provider Demographics
NPI:1235470576
Name:DELPOZO, AGATHA MARIE (RN, LMT)
Entity Type:Individual
Prefix:
First Name:AGATHA
Middle Name:MARIE
Last Name:DELPOZO
Suffix:
Gender:F
Credentials:RN, LMT
Other - Prefix:
Other - First Name:AGATHA
Other - Middle Name:
Other - Last Name:BAQUERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:14339 WATERSIDE LN
Mailing Address - Street 2:
Mailing Address - City:BROOMFIELD
Mailing Address - State:CO
Mailing Address - Zip Code:80023-4526
Mailing Address - Country:US
Mailing Address - Phone:561-350-7446
Mailing Address - Fax:
Practice Address - Street 1:938 BANNOCK ST STE 100
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4031
Practice Address - Country:US
Practice Address - Phone:303-602-8951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-12
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO163WCO400X163WC0400X
COMT0012709173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No173C00000XOther Service ProvidersReflexologist