Provider Demographics
NPI:1760234892
Name:DIETERMAN, JOSHUA (RN)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:DIETERMAN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:631 ASH WAY
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-5978
Mailing Address - Country:US
Mailing Address - Phone:562-475-3900
Mailing Address - Fax:
Practice Address - Street 1:321 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-2011
Practice Address - Country:US
Practice Address - Phone:714-992-7093
Practice Address - Fax:714-992-9923
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95135839163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health