Provider Demographics
NPI:1720312622
Name:CICCIU, H GREGORH (LAC CO)
Entity Type:Individual
Prefix:
First Name:H
Middle Name:GREGORH
Last Name:CICCIU
Suffix:
Gender:M
Credentials:LAC CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17215 W 16TH PL
Mailing Address - Street 2:
Mailing Address - City:GOLDEN
Mailing Address - State:CO
Mailing Address - Zip Code:80401-2754
Mailing Address - Country:US
Mailing Address - Phone:303-274-5733
Mailing Address - Fax:
Practice Address - Street 1:17215 W 16TH PL
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2754
Practice Address - Country:US
Practice Address - Phone:303-274-5733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO501171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist