Healthcare Provider Details

I. General information

NPI: 1225660616
Provider Name (Legal Business Name): JULIET GAR BEK HIGA RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1024 S LEMAY AVE
FORT COLLINS CO
80524-3929
US

IV. Provider business mailing address

8361 WYNSTONE CT
WINDSOR CO
80550-8054
US

V. Phone/Fax

Practice location:
  • Phone: 970-495-8205
  • Fax:
Mailing address:
  • Phone: 970-214-8235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number813094
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: