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NPI Code Detail

MEDICARE: ROMAN DIETRICH PSY.D.

MEDICARE: ROMAN DIETRICH PSY.D.
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
1390200000XStudent in an Organized Health Care Education/Training Program
2103T00000XPsychologist29575CA
3106H00000XMarriage & Family TherapistIMF 44745CA

General Provider Information

NPI Number : 1194857730
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROMAN DIETRICH PSY.D.
Provider Business Mailing Address
First Line : 3994 PINOCHE PEAK WAY
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95742-7731
Country : US
Telephone Number : 714-309-8585
Fax Number :
Provider Business Practice Location Address
First Line : 7707 AUSTIN RD
Second Line :
City : STOCKTON
State : CA
Zip : 95215-8312
Country : US
Telephone Number : 209-467-3605
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2007
Last Update Date : 05/03/2023

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