Provider Demographics
NPI:1689979593
Name:CORCA, DAMIANA (LAC)
Entity Type:Individual
Prefix:DR
First Name:DAMIANA
Middle Name:
Last Name:CORCA
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 1:3825 IRIS AVE
Mailing Address - Street 2:SUITE 250B
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301
Mailing Address - Country:US
Mailing Address - Phone:303-440-1033
Mailing Address - Fax:
Practice Address - Street 1:3825 IRIS AVE
Practice Address - Street 2:SUITE 250B
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301
Practice Address - Country:US
Practice Address - Phone:303-440-1033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-24
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2766171100000X
TN168171100000X
COAW1694171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist