Healthcare Provider Details

I. General information

NPI: 1649754391
Provider Name (Legal Business Name): VALENCIA MARIE GREENE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2018
Last Update Date: 07/22/2025
Certification Date: 07/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST
DENVER CO
80204-4597
US

IV. Provider business mailing address

777 BANNOCK ST
DENVER CO
80204-4597
US

V. Phone/Fax

Practice location:
  • Phone: 303-303-4364
  • Fax: 303-602-6931
Mailing address:
  • Phone: 303-303-4364
  • Fax: 303-602-6931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.0005551
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: