Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | 40824 | CO |
NPI | 1942273479 |
---|---|
Provider Name | Maria Sherrilyn Dellota |
First Address | Fort Collins, CO 80526-1849 |
Second Address | Fort Collins, CO 80526-1849 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/02/2006 |
Last Update Date | 29/10/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
61858731 | (05) | CO |
H05512 | (02) |