Individual
MS. DIANE MUNYON DIETTERLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
34012 EL CONTENTO DR, DANA POINT, CA 92629-2666
(949) 525-8795
(949) 489-0264
Mailing address
34012 EL CONTENTO DR, DANA POINT, CA 92629-2666
(949) 525-8795
(949) 489-0264
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
199901
CA
363LA2200X
Adult Health Nurse Practitioner
Primary
11140
CA
363LW0102X
Women's Health Nurse Practitioner
11140
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
108971
MEDICARE NUMBER: INACTIVE
OR
01
—
S95183
UPIN
OR
Enumeration date
02/12/2008
Last updated
02/12/2008
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