Individual
DEJAN PETROVIC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
7382 HALITE CT, CASTLE ROCK, CO 80108-3023
(818) 699-4222
Mailing address
4340 PEBBLE RIDGE CIR APT 152, COLORADO SPRINGS, CO 80906-6531
(701) 330-9501
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1144936857
—
CO
05
—
1154022614
—
CO
Enumeration date
06/07/2023
Last updated
06/07/2023
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