Provider Demographics
NPI:1457172025
Name:HEREDIA, AALIYAH
Entity type:Individual
Prefix:
First Name:AALIYAH
Middle Name:
Last Name:HEREDIA
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 1:2660 W HOLDEN PL
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-3300
Mailing Address - Country:US
Mailing Address - Phone:347-679-3168
Mailing Address - Fax:
Practice Address - Street 1:3460 S FEDERAL BLVD
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:CO
Practice Address - Zip Code:80110-1967
Practice Address - Country:US
Practice Address - Phone:347-679-3168
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator