Healthcare Provider Details

I. General information

NPI: 1891893293
Provider Name (Legal Business Name): PAUL JOHN DIETSCH B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 11/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 S EL CAMINO REAL STE 14
OCEANSIDE CA
92054-6391
US

IV. Provider business mailing address

5882 BOLSA AVE., SUITE 130
HUNTINGTON BEACH CA
92649-1170
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-5755
  • Fax:
Mailing address:
  • Phone: 714-898-5732
  • Fax: 714-901-4058

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHA0000135
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: