Provider Demographics
NPI:1275782682
Name:GRIFFIN, DINA (RD)
Entity Type:Individual
Prefix:
First Name:DINA
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials: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 18286
Mailing Address - Street 2:2900 VALMONT RD, SUITE G
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80308-1286
Mailing Address - Country:US
Mailing Address - Phone:303-440-1015
Mailing Address - Fax:
Practice Address - Street 1:2900 VALMONT RD
Practice Address - Street 2:SUITE G
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-440-1015
Practice Address - Fax:303-440-8990
Is Sole Proprietor?:No
Enumeration Date:2008-09-10
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO972797133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered