Provider Demographics
NPI:1497802565
Name:DEL REGATO, HEIDI M (LAC)
Entity Type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:M
Last Name:DEL REGATO
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80104-0358
Mailing Address - Country:US
Mailing Address - Phone:305-389-8044
Mailing Address - Fax:888-267-9159
Practice Address - Street 1:19 WILCOX ST
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-1904
Practice Address - Country:US
Practice Address - Phone:303-814-9262
Practice Address - Fax:888-267-9159
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC9343171100000X
FLAP2197171100000X
COACU-1610171100000X
CAMA03172225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist