Healthcare Provider Details

I. General information

NPI: 1144146101
Provider Name (Legal Business Name): MARCELA REQUENA ILIEV
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 S AIRPORT BLVD STE 180
AURORA CO
80017-2253
US

IV. Provider business mailing address

440 S AIRPORT BLVD STE 180
AURORA CO
80017-2253
US

V. Phone/Fax

Practice location:
  • Phone: 303-418-4935
  • Fax:
Mailing address:
  • Phone: 303-418-4935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: