Provider Demographics
NPI:1346399003
Name:BARRON DE LICON, LUZ IMELDA
Entity Type:Individual
Prefix:MRS
First Name:LUZ
Middle Name:IMELDA
Last Name:BARRON DE LICON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80212-7091
Mailing Address - Country:US
Mailing Address - Phone:303-200-9656
Mailing Address - Fax:
Practice Address - Street 1:3675 CHASE ST
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80212-7091
Practice Address - Country:US
Practice Address - Phone:303-200-9656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8995374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide