Healthcare Provider Details

I. General information

NPI: 1013763960
Provider Name (Legal Business Name): MRS. ANA CLEMENTS-BENEDICT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANA CLEMENTS-BENEDICT

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S JACKSON ST STE 520
DENVER CO
80209-3133
US

IV. Provider business mailing address

2308 S ACOMA ST
DENVER CO
80223-4309
US

V. Phone/Fax

Practice location:
  • Phone: 303-704-4062
  • Fax:
Mailing address:
  • Phone: 301-529-1254
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: