Individual
THERESA MARIE DICAMILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MEDICAL ASSISTANT
Contact information
Practice address
4851 INDEPENDENCE ST, WHEAT RIDGE, CO 80033-6715
(303) 432-5040
Mailing address
4851 INDEPENDENCE ST, WHEAT RIDGE, CO 80033-6715
(303) 432-5040
Taxonomy
Speciality
Code
Description
License number
State
103TP0016X
Prescribing (Medical) Psychologist
Primary
2745171
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20308
BASIC LIFE SUPPORT
CO
01
—
2745171
AMERICAN MEDICAL TECHNOLOGISTS
CO
Enumeration date
07/25/2015
Last updated
07/25/2015
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