{
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"EIN": null,
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"IsOrgSubpart": "N",
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"OrgName": "FW DIETERICH MD INC",
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"NameSuffix": null,
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"FirstLineMailingAddress": "1275 N. ROSE DR",
"SecondLineMailingAddress": "SUITE 106",
"MailingAddressCityName": "PLACENTIA",
"MailingAddressStateName": "CA",
"MailingAddressPostalCode": "92870-3945",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "714-572-1921",
"MailingAddressFaxNumber": "714-572-8334",
"FirstLinePracticeLocationAddress": "1275 N. ROSE DR",
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"PracticeLocationAddressCityName": "PLACENTIA",
"PracticeLocationAddressStateName": "CA",
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"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "714-572-1921",
"PracticeLocationAddressFaxNumber": "714-572-8334",
"EnumerationDate": "04/23/2009",
"LastUpdateDate": "04/08/2016",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": null,
"Gender": null,
"AuthorizedOfficialLastName": "DIETERICH",
"AuthorizedOfficialFirstName": "FREDERICK",
"AuthorizedOfficialMiddleName": "W",
"AuthorizedOfficialTitle": "PRESIDENT",
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"AuthorizedOfficialCredential": "M.D.",
"AuthorizedOfficialTelephoneNumber": "714-572-1921",
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "207V00000X",
"TaxonomyName": "Obstetrics & Gynecology Physician",
"LicenseNumber": "G41537",
"LicenseNumberStateCode": "CA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}