Provider Demographics
NPI:1750119913
Name:MEZENTSEVA, YULIYA
Entity type:Individual
Prefix:
First Name:YULIYA
Middle Name:
Last Name:MEZENTSEVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12596 W BAYAUD AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80228-2035
Mailing Address - Country:US
Mailing Address - Phone:720-638-7500
Mailing Address - Fax:720-812-5134
Practice Address - Street 1:12596 W BAYAUD AVE STE 100
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-2035
Practice Address - Country:US
Practice Address - Phone:720-638-7500
Practice Address - Fax:720-812-5134
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
COPA.8985363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant