Healthcare Provider Details

I. General information

NPI: 1891657961
Provider Name (Legal Business Name): JENNIFER AZUL REQUENA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 GARDEN OF THE GODS RD
COLORADO SPRINGS CO
80907-3489
US

IV. Provider business mailing address

592 VAIL CIR
DILLON CO
80435-8303
US

V. Phone/Fax

Practice location:
  • Phone: 970-232-0203
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: