MEDICARE: DIMITRI AKENTEN

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
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1710670062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIMITRI AKENTEN

Provider Business Mailing Address
First Line	:	2355 W LE MARCHE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4122
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2355 W LE MARCHE AVE
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85023-4122
Country	:	US
Telephone Number	:	623-688-6925
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2023
Last Update Date	:	01/10/2025

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Directions to “ DIMITRI AKENTEN ” Practice Location

Language	Start Address	Practice Location

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