Provider Demographics
NPI:1073956348
Name:UCEDA, LUIS ROBERT (MA)
Entity Type:Individual
Prefix:MR
First Name:LUIS
Middle Name:ROBERT
Last Name:UCEDA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:ROBERT
Other - Middle Name:
Other - Last Name:UCEDA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:10782 E ALAMEDA AVE
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-1017
Mailing Address - Country:US
Mailing Address - Phone:303-923-2300
Mailing Address - Fax:303-617-2672
Practice Address - Street 1:6171 W CHARLESTON BLVD
Practice Address - Street 2:BLDG 7
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-1126
Practice Address - Country:US
Practice Address - Phone:702-486-0877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-16
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2789101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)