Healthcare Provider Details

I. General information

NPI: 1235885054
Provider Name (Legal Business Name): MELISSA GUARDIANO LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6881 S HOLLY CIR STE 207
CENTENNIAL CO
80112-1145
US

IV. Provider business mailing address

6881 S HOLLY CIR STE 207
CENTENNIAL CO
80112-1145
US

V. Phone/Fax

Practice location:
  • Phone: 303-221-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberACU.0002713
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: