Healthcare Provider Details

I. General information

NPI: 1811438393
Provider Name (Legal Business Name): LENA PASTERNAK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LENA BAZHENOVA DO

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 10/07/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2625 W PUEBLO BLVD
PUEBLO CO
81004-3816
US

IV. Provider business mailing address

10350 E DAKOTA AVE
DENVER CO
80247-1314
US

V. Phone/Fax

Practice location:
  • Phone: 303-338-4545
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL.0006407
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberTL.0006407
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0062434
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: