Healthcare Provider Details

I. General information

NPI: 1699036491
Provider Name (Legal Business Name): ELENA ILIEVA PASKOVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2012
Last Update Date: 03/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3955 E EXPOSITION AVE STE 320
DENVER CO
80209-5033
US

IV. Provider business mailing address

1273 S MONACO PKWY
DENVER CO
80224-1811
US

V. Phone/Fax

Practice location:
  • Phone: 303-777-1151
  • Fax:
Mailing address:
  • Phone: 720-277-8578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMT-12963
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberPT 0012076
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: