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NPI Code Detail

MEDICARE: JUSTIN DIETZEL

MEDICARE: JUSTIN DIETZEL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior TechnicianBACB1486775CO

General Provider Information

NPI Number : 1679432421
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUSTIN DIETZEL
Provider Business Mailing Address
First Line : 222 KNOX CT
Second Line :
City : DENVER
State : CO
Zip : 80219-1440
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8354 E NORTHFIELD BLVD UNIT 3700
Second Line :
City : DENVER
State : CO
Zip : 80238-3135
Country : US
Telephone Number : 616-550-4252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/19/2026
Last Update Date : 01/19/2026

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Directions to “ JUSTIN DIETZEL ” Practice Location

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