Healthcare Provider Details

I. General information

NPI: 1902646821
Provider Name (Legal Business Name): ANNABELLE DIVITA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 09/20/2026
Certification Date: 09/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21825 E QUINCY AVE
AURORA CO
80018-3155
US

IV. Provider business mailing address

21825 E QUINCY AVE
AURORA CO
80018-3155
US

V. Phone/Fax

Practice location:
  • Phone: 303-398-6340
  • Fax:
Mailing address:
  • Phone: 303-398-6340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number0009925047
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: