Individual
DR. TODD B DIETRICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 S RAYMOND AVE, PASADENA, CA 91105-3229
(626) 795-8051
(626) 795-0356
Mailing address
PO BOX 90730, PASADENA, CA 91109-0730
(626) 795-8051
(626) 795-0356
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A70565
CA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
A70565
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A70565
MEDICARE INDIVIDULA ID #
CA
01
—
P00205814
RAIL ROAD MEDICARE
CA
Enumeration date
09/27/2005
Last updated
06/27/2024
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