Provider Demographics
NPI:1962877027
Name:BEYENE, GLORIA
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:BEYENE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 S PARKER RD STE 409
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-2713
Mailing Address - Country:US
Mailing Address - Phone:720-999-7430
Mailing Address - Fax:
Practice Address - Street 1:14261 E 1ST DR UNIT 308
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80011-3835
Practice Address - Country:US
Practice Address - Phone:720-999-7430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46-4952686171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO46-4952686OtherTRANSPORTION