Individual
PAUL DIEDRICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2704 N TENAYA WAY, LAS VEGAS, NV 89128-0424
(028) 775-1997
(702) 363-8753
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 877-5199
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA870
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100504091
—
NV
05
—
100504092
—
NV
Enumeration date
01/24/2006
Last updated
12/04/2024
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