Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
DR. JONATHAN DIETZ, D.O.
Active Sole ProprietorDR. JONATHAN DIETZ, D.O. is a Adolescent Medicine healthcare provider located in SAN RAFAEL, California. NPI 1366566499 is currently active in the NPPES registry. Verify at CMS.
Adolescent Medicine · SAN RAFAEL, CA
Registration Details
- NPI Number
- 1366566499
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Mar 16, 2007 (19.444724377892 yrs)
- Last Updated
- Jul 8, 2007
- License
-
20A7626 (CA)
- Sole Proprietor
- Yes
Practice Information
- Address
-
540 D ST2SAN RAFAEL, CA, 949013867Browse CA providers · Browse ZIP 94901
- Phone
- 4154597416
- Primary Specialty
-
Adolescent Medicine
207QA0505X
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.