Provider Demographics
NPI:1639738495
Name:GOTTLIEB, YAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:YAEL
Middle Name:
Last Name:GOTTLIEB
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 DAHLIA ST APT 203
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4224
Mailing Address - Country:US
Mailing Address - Phone:303-829-5483
Mailing Address - Fax:
Practice Address - Street 1:1100 FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-3219
Practice Address - Country:US
Practice Address - Phone:303-436-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-06
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO363A00000X
390200000X
COPA.0005841363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program