Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080N0001X | Neonatal-Perinatal Doctor | G51784 | CA |
NPI | 1033139951 |
---|---|
Provider Name | Dr. Jeffrey Thomas Pietz |
First Address | Madera, CA 93636-8761 |
Second Address | Madera, CA 93636-8761 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 20/10/2021 |