Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic |
NPI | 1457800781 |
---|---|
Provider Name | Ms. Regina Maria Victoria |
First Address | Denver, CO 80212-2418 |
Second Address | Lafayette, CO 80026-3370 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2016 |
Last Update Date | 28/09/2016 |