Individual
DR. JONATHAN DIETZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
540 D ST, 2, SAN RAFAEL, CA 94901-3867
(415) 459-7416
Mailing address
540 D ST, 2, SAN RAFAEL, CA 94901-3867
(415) 459-7416
Taxonomy
Speciality
Code
Description
License number
State
207QA0505X
Adult Medicine Physician
Primary
20A7626
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09171981
SON'S BIRTH
NM
Enumeration date
03/16/2007
Last updated
07/08/2007
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