Provider Demographics
NPI:1891179743
Name:SKENDEROVA, MARTINA (LAC)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:SKENDEROVA
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 1:7150 W 24TH AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80214-6261
Mailing Address - Country:US
Mailing Address - Phone:720-663-9787
Mailing Address - Fax:
Practice Address - Street 1:5700 W 25TH AVE STE 200C
Practice Address - Street 2:
Practice Address - City:EDGEWATER
Practice Address - State:CO
Practice Address - Zip Code:80214-1282
Practice Address - Country:US
Practice Address - Phone:720-663-9787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002052171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist