MEDICARE: LAUREN DIETZ RN

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	163WP2201X	Ambulatory Care Registered Nurse	842808	CA
2	363LA2200X	Adult Health Nurse Practitioner	95031222	CA

General Provider Information

NPI Number	:	1508503194
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN DIETZ RN

Provider Business Mailing Address
First Line	:	1753 CARROLL AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94124-2647
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1753 CARROLL AVE
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94124-2647
Country	:	US
Telephone Number	:	415-712-0501
Fax Number	:

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

Provider Enumeration Date	:	05/16/2022
Last Update Date	:	05/09/2025

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Directions to “ LAUREN DIETZ RN” Practice Location

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