Healthcare Provider Details

I. General information

NPI: 1780157354
Provider Name (Legal Business Name): JANIS PRETTITORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/07/2019
Last Update Date: 01/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BLAKE STREET
DENVER CO
80205
US

IV. Provider business mailing address

738 S GAYLORD ST
DENVER CO
80209-4630
US

V. Phone/Fax

Practice location:
  • Phone: 720-419-2187
  • Fax:
Mailing address:
  • Phone: 970-316-1624
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB471991
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: