Provider Demographics
NPI:1093577462
Name:LOMA, DESTINIE S
Entity type:Individual
Prefix:
First Name:DESTINIE
Middle Name:S
Last Name:LOMA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1727 ROWAN LN
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:CO
Mailing Address - Zip Code:80620-2368
Mailing Address - Country:US
Mailing Address - Phone:970-702-6084
Mailing Address - Fax:
Practice Address - Street 1:1727 ROWAN LN
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:CO
Practice Address - Zip Code:80620-2368
Practice Address - Country:US
Practice Address - Phone:970-702-6084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO680058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst