Provider Demographics
NPI:1710944426
Name:DIETRICH, ROSALIND B (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSALIND
Middle Name:B
Last Name:DIETRICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MC 8756
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9000
Mailing Address - Country:US
Mailing Address - Phone:619-543-6766
Mailing Address - Fax:619-543-3736
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 8756
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9000
Practice Address - Country:US
Practice Address - Phone:619-543-6766
Practice Address - Fax:619-543-3736
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA368112085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A368110Medicaid
CA00A368110Medicaid
CAWA36811EMedicare ID - Type Unspecified
CAWA36811FMedicare ID - Type Unspecified