Provider Demographics
NPI:1447404348
Name:MIERA, MARIQITTA L
Entity Type:Individual
Prefix:MISS
First Name:MARIQITTA
Middle Name:L
Last Name:MIERA
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 1:8500 ESSEX DR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80229-5010
Mailing Address - Country:US
Mailing Address - Phone:720-277-2471
Mailing Address - Fax:
Practice Address - Street 1:12774 COLORADO BLVD
Practice Address - Street 2:SUITE141
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-2888
Practice Address - Country:US
Practice Address - Phone:303-457-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2010-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist