Provider Demographics
NPI:1780821710
Name:DIETRICH, SUZANNE MARIE (RD)
Entity type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:MARIE
Last Name:DIETRICH
Suffix:
Gender:
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 FLORIDA AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4438
Mailing Address - Country:US
Mailing Address - Phone:209-577-3388
Mailing Address - Fax:209-527-2897
Practice Address - Street 1:1541 FLORIDA AVE STE 200
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4438
Practice Address - Country:US
Practice Address - Phone:209-577-3388
Practice Address - Fax:209-527-2897
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered