Healthcare Provider Details

I. General information

NPI: 1346296795
Provider Name (Legal Business Name): MARIA DEE IBACH PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARIA D LATZKA

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10240 PARK MEADOWS DR
LONE TREE CO
80124-5425
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number103988
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0001193
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: