Provider Demographics
NPI:1811216724
Name:GERBOTH, REGINA (RM, CPM, IBCLC)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:
Last Name:GERBOTH
Suffix:
Gender:F
Credentials:RM, CPM, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2767 S NEWTON WAY
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80236-2215
Mailing Address - Country:US
Mailing Address - Phone:720-588-4462
Mailing Address - Fax:720-302-0055
Practice Address - Street 1:2767 S NEWTON WAY
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80236-2215
Practice Address - Country:US
Practice Address - Phone:720-588-4462
Practice Address - Fax:720-302-0055
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2015-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMWR-122176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife