Provider Demographics
NPI:1225538366
Name:STANFORD, RITA FRANCES
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:FRANCES
Last Name:STANFORD
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 1:2760 29TH ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1295
Mailing Address - Country:US
Mailing Address - Phone:303-443-1243
Mailing Address - Fax:
Practice Address - Street 1:2760 29TH ST STE 1D
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1295
Practice Address - Country:US
Practice Address - Phone:303-443-1243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO258171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20-4109515OtherACUPUNCTURE
CO20-4109515OtherACUPUNCTURE