Healthcare Provider Details

I. General information

NPI: 1386579282
Provider Name (Legal Business Name): ELMA YULIANA CORDOVA PENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2026
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 E 12TH AVE
DENVER CO
80220-2415
US

IV. Provider business mailing address

17239 E HAMILTON AVE
AURORA CO
80013-2060
US

V. Phone/Fax

Practice location:
  • Phone: 303-504-7700
  • Fax:
Mailing address:
  • Phone: 303-504-1209
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number11-166-0672
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: