Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | L6358 | TX |
N | 2080A0000X | Adolescent Medicine | L6358 | TX |
NPI | 1053401216 |
---|---|
Provider Name | Dr. Jennifer E. Dietrich |
First Address | Houston, TX 77210-4775 |
Second Address | Houston, TX 77030-2348 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2006 |
Last Update Date | 01/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
187205302 | (05) | TX |
I08785 | (02) |