MEDICARE: DANIELA JARAMILLO L.AC., LMT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	225700000X	Massage Therapist	MT.0012390	CO
2	171100000X	Acupuncturist	ACU.0002500	CO

General Provider Information

NPI Number	:	1811391410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIELA JARAMILLO L.AC., LMT

Provider Business Mailing Address
First Line	:	225 E CHEYENNE MOUNTAIN BLVD STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3700
Country	:	US
Telephone Number	:	719-232-9173
Fax Number	:

Provider Business Practice Location Address
First Line	:	225 E CHEYENNE MOUNTAIN BLVD STE 130
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80906-3700
Country	:	US
Telephone Number	:	719-232-9173
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/10/2014
Last Update Date	:	02/09/2022

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