Individual
KELLY DIETZEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LM
Contact information
Practice address
1327 CAMPBELL ST, GLENDALE, CA 91207-1446
(323) 240-4024
Mailing address
1327 CAMPBELL ST, GLENDALE, CA 91207-1446
(323) 240-4024
Taxonomy
Speciality
Code
Description
License number
State
176B00000X
Midwife
Primary
257
CA
Other
Enumeration date
01/17/2011
Last updated
01/17/2011
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