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General NPI Number Information
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NPI Number | 1588367304
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Entity Type | Individual
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Provider Name | KATHRYN DIETZ
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Gender | Female
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Dates
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Enumeration Date | 03/22/2023
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Last Update Date | 11/01/2024
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Provider Practice Location Address
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Address Line | 1845 BUSINESS CENTER DR STE 214
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-3447
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Country | US
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Telephone | 951-465-5692
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Fax |
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Provider Business Mailing Address
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Address Line | 25449 YOLANDA AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92551-4544
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Country | US
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Telephone | 951-902-5447
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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 | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 131599
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 150807
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License Number State |
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