Healthcare Provider Details

I. General information

NPI: 1972888907
Provider Name (Legal Business Name): KARIN S DIETRICH MNT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2011
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8205 S POPLAR WAY SUITE 203
CENTENNIAL CO
80112-3145
US

IV. Provider business mailing address

8200 S QUEBEC ST SUITE A-3
CENTENNIAL CO
80112-4411
US

V. Phone/Fax

Practice location:
  • Phone: 303-912-1100
  • Fax: 720-223-7510
Mailing address:
  • Phone: 303-912-1100
  • Fax: 720-223-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: