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General NPI Number Information
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NPI Number | 1578345401
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Entity Type | Individual
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Provider Name | JOVENAR DIWAYAN ULEP SURGICAL ASSISTANT
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Gender | Male
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Dates
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Enumeration Date | 10/16/2023
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 1919 E 18TH AVE
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City | DENVER
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State | CO
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Zip | 80206-1107
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Country | US
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Telephone | 303-322-3993
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Fax |
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Provider Business Mailing Address
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Address Line | 19374 E PURDUE CIR
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City | AURORA
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State | CO
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Zip | 80013-4514
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Country | US
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Telephone | 303-328-7057
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 246ZC0007X
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Taxonomy Name | Surgical Assistant
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License Number | SA.0003384
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License Number State | CO
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