Individual
FERNANDO DIETSCH JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
723 MEMORIAL ST, PROSSER, WA 99350-1524
(509) 786-2222
(509) 786-6612
Mailing address
21 W IMPERIAL ST, WALLA WALLA, WA 99362-4457
(509) 301-9342
(509) 786-6612
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00041643
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
162391
LABOR & INDUSTRIES #
WA
05
—
8325656
—
WA
Enumeration date
05/17/2006
Last updated
07/09/2007
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