Provider Demographics
NPI:1427453885
Name:MASCUCH, JOAQUINA (LAC)
Entity type:Individual
Prefix:
First Name:JOAQUINA
Middle Name:
Last Name:MASCUCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:JOAQUINA
Other - Middle Name:
Other - Last Name:WOOD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC
Mailing Address - Street 1:3775 IRIS AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-2043
Mailing Address - Country:US
Mailing Address - Phone:303-447-0443
Mailing Address - Fax:
Practice Address - Street 1:1115 BROADWAY ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80203
Practice Address - Country:US
Practice Address - Phone:303-534-1675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-28
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACU0001919171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist