MEDICARE: MARCELA REQUENA ILIEV

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	124Q00000X	Dental Hygienist

General Provider Information

NPI Number	:	1144146101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARCELA REQUENA ILIEV

Provider Business Mailing Address
First Line	:	440 S AIRPORT BLVD STE 180
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-2253
Country	:	US
Telephone Number	:	303-418-4935
Fax Number	:

Provider Business Practice Location Address
First Line	:	440 S AIRPORT BLVD STE 180
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80017-2253
Country	:	US
Telephone Number	:	303-418-4935
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2026
Last Update Date	:	06/25/2026

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Directions to “ MARCELA REQUENA ILIEV ” Practice Location

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