Healthcare Provider Details

I. General information

NPI: 1649190760
Provider Name (Legal Business Name): JACOB JOHN LALUYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2026
Last Update Date: 07/18/2026
Certification Date: 07/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5944 S KIPLING PKWY STE 202
LITTLETON CO
80127-2590
US

IV. Provider business mailing address

11919 E DEL TIMBRE DR
SCOTTSDALE AZ
85259-6336
US

V. Phone/Fax

Practice location:
  • Phone: 720-713-1909
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0024757
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: