Organization
PATRICIA A DIETZGEN DO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PATRICIA A DIETZGEN DO (OWNER)
(480) 961-0760
Entity
Organization
Contact information
Practice address
16515 S 40TH ST, SUITE 103, PHOENIX, AZ 85048-0558
(480) 961-0760
(480) 961-0761
Mailing address
16515 S 40TH ST, SUITE 103, PHOENIX, AZ 85048-0558
(480) 961-0760
(480) 961-0761
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DE7249
PALMETO GBA
AZ
Enumeration date
10/12/2007
Last updated
01/19/2011
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