Provider Demographics
NPI:1346318979
Name:WYZGA, CYNTHIA L (LAC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:L
Last Name:WYZGA
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 1:12461 N EVERGREEN TRL
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80138-8208
Mailing Address - Country:US
Mailing Address - Phone:303-841-7141
Mailing Address - Fax:303-841-4942
Practice Address - Street 1:10841 S CROSSROADS DR
Practice Address - Street 2:STE 207
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9000
Practice Address - Country:US
Practice Address - Phone:303-841-7141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO902171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist