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General NPI Number Information
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NPI Number | 1053341669
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Entity Type | Individual
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Provider Name | DANIEL SCOTT DIETRICH MD
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 546 E PINE ST
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City | STOCKTON
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State | CA
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Zip | 95204-5525
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Country | US
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Telephone | 209-467-1000
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Fax | 209-464-4439
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Provider Business Mailing Address
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Address Line | 546 E PINE ST
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City | STOCKTON
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State | CA
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Zip | 95204-5525
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Country | US
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Telephone | 209-467-1000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | A95731
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License Number State | CA
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