Healthcare Provider Details

I. General information

NPI: 1013832682
Provider Name (Legal Business Name): AVENIR V GORKOVCHENKO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

771 THORNTON PKWY
THORNTON CO
80229-3680
US

IV. Provider business mailing address

771 THORNTON PKWY
THORNTON CO
80229-3680
US

V. Phone/Fax

Practice location:
  • Phone: 303-280-8218
  • Fax: 303-452-0563
Mailing address:
  • Phone: 303-280-8218
  • Fax: 303-452-0563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberIN.0002009978
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: