Provider Demographics
NPI:1740515550
Name:AMESCUA, AVA MARIE (LMT, LAC)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:MARIE
Last Name:AMESCUA
Suffix:
Gender:F
Credentials:LMT, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1859 S FLANDERS WAY
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80017-4631
Mailing Address - Country:US
Mailing Address - Phone:720-291-3102
Mailing Address - Fax:
Practice Address - Street 1:1859 S FLANDERS WAY
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80017-4631
Practice Address - Country:US
Practice Address - Phone:720-291-3102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU.0002044171100000X
COMT.0013169171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist