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General NPI Number Information
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NPI Number | 1811920002
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Entity Type | Individual
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Provider Name | GARRY P. DIETER MD
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Gender | Male
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Dates
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Enumeration Date | 07/09/2006
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Last Update Date | 09/08/2021
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Provider Practice Location Address
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Address Line | UCLA DEPT ANESTHESIOLOGY AND PERIOP MEDICINE
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City | LOS ANGELES
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State | CA
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Zip | 90095-3129
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Country | US
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Telephone | 310-267-8653
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Fax |
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Provider Business Mailing Address
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Address Line | 757 WESTWOOD PLZ STE 3304
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City | LOS ANGELES
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State | CA
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Zip | 90095-9780
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Country | US
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Telephone | 310-267-0902
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 9767
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 9767
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License Number State | MT
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