Healthcare Provider Details

I. General information

NPI: 1730367392
Provider Name (Legal Business Name): LIVE WELL VENTURES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2008
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 VANCE ST # 201
WHEAT RIDGE CO
80033-6298
US

IV. Provider business mailing address

3760 VANCE ST # 201
WHEAT RIDGE CO
80033-6298
US

V. Phone/Fax

Practice location:
  • Phone: 303-902-2680
  • Fax:
Mailing address:
  • Phone: 303-902-2680
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDR-43822
License Number StateCO

VIII. Authorized Official

Name: DR. DENISE HERNANDEZ
Title or Position: PRESIDENT
Credential: MD
Phone: 303-902-2680