Provider Demographics
NPI:1639757693
Name:DELAGARZA, CRISTA M (MA, LMT)
Entity type:Individual
Prefix:
First Name:CRISTA
Middle Name:M
Last Name:DELAGARZA
Suffix:
Gender:F
Credentials:MA, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 S. BROADWAY
Mailing Address - Street 2:MANDALA
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80305-1890
Mailing Address - Country:US
Mailing Address - Phone:303-859-2441
Mailing Address - Fax:
Practice Address - Street 1:825 S. BROADWAY
Practice Address - Street 2:MANDALA
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80305
Practice Address - Country:US
Practice Address - Phone:303-859-2441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225700000X
CO2089225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist