Provider Demographics
NPI:1275768475
Name:MORTELLARO, GINA MARIE (LAC, CH DIPL OM)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:MARIE
Last Name:MORTELLARO
Suffix:
Gender:F
Credentials:LAC, CH DIPL OM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7114 W JEFFERSON AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80235-2356
Mailing Address - Country:US
Mailing Address - Phone:303-997-9414
Mailing Address - Fax:303-593-4651
Practice Address - Street 1:7114 W JEFFERSON AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80235-2354
Practice Address - Country:US
Practice Address - Phone:303-997-9414
Practice Address - Fax:303-593-4651
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-18
Last Update Date:2009-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO1371171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist