Healthcare Provider Details

I. General information

NPI: 1285516773
Provider Name (Legal Business Name): MARIA UBERNA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 10/20/2025
Certification Date: 10/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11172 HURON ST STE 20
NORTHGLENN CO
80234-4380
US

IV. Provider business mailing address

105 COMMERCIAL CENTER DR
RUSKIN FL
33573-6827
US

V. Phone/Fax

Practice location:
  • Phone: 303-568-9694
  • Fax: 970-639-4475
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009436
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: