Healthcare Provider Details

I. General information

NPI: 1730527037
Provider Name (Legal Business Name): RIAN CELONA GUFAROTTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2013
Last Update Date: 06/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4751 N ACADEMY BLVD SUITE B
COLORADO SPRINGS CO
80918-4268
US

IV. Provider business mailing address

4751 N ACADEMY BLVD SUITE B
COLORADO SPRINGS CO
80918-4268
US

V. Phone/Fax

Practice location:
  • Phone: 719-201-9153
  • Fax:
Mailing address:
  • Phone: 719-201-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT.0005436
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: