Healthcare Provider Details

I. General information

NPI: 1225320534
Provider Name (Legal Business Name): CAMERON DIETIKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2011
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 PARNASSUS AVE
SAN FRANCISCO CA
94143-2204
US

IV. Provider business mailing address

505 PARNASSUS AVE BOX 0114 UCSF DEPARTMENT OF NEUROLOGY
SAN FRANCISCO CA
94143-0114
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3891
  • Fax:
Mailing address:
  • Phone: 415-476-3891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA124735
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: