Provider Demographics
NPI:1548485246
Name:DIETSCH, BERNARD FRANCIS
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:FRANCIS
Last Name:DIETSCH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:689 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4009
Mailing Address - Country:US
Mailing Address - Phone:619-579-8455
Mailing Address - Fax:919-579-9129
Practice Address - Street 1:689 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4009
Practice Address - Country:US
Practice Address - Phone:619-579-8455
Practice Address - Fax:919-579-9129
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA1074237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31734ZMedicaid