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NPI Code Detail

MEDICARE: MS. LAUREN ELIZABETH DIETZ

MEDICARE: MS. LAUREN ELIZABETH DIETZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior AnalystLA

General Provider Information

NPI Number : 1902453319
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LAUREN ELIZABETH DIETZ
Provider Business Mailing Address
First Line : 21600 OXNARD ST STE 1800
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91367-7807
Country : US
Telephone Number : 818-345-2345
Fax Number : --
Provider Business Practice Location Address
First Line : 209 CENTRE SARCELLE BLVD STE 201
Second Line :
City : YOUNGSVILLE
State : LA
Zip : 70592-6755
Country : US
Telephone Number : 337-573-1083
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2019
Last Update Date : 08/20/2019

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