DR. PETER DIETZE JR. (NPI# 1336259290) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336259290 |
| Entity Type | Individual |
| Full Name | DR. PETER DIETZE JR. |
| Credential | MD |
| Practice Address |
10243 Genetic Center Dr San Diego CA 92121-6310 |
| Practice Telephone | 8584992702 |
| Practice Fax Number | 8585266113 |
| Mailing Telephone | 8584992702 |
| Mailing Fax Number | 8585266113 |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2013-06-18 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207V00000X | Obstetrics & Gynecology | G 79877 | CA | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | 00G 798770 | 05 |
| Street Address |
10243 GENETIC CENTER DR |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92121-6310 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346240967 | Eric R Lovell | Emergency Medicine | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2005-07-26 |
| 1811551930 | Samantha Timanus | Physical Therapist | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2019-04-24 |
| 1689169062 | Ylan Ton | Physical Therapist | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2018-06-27 |
| 1861908386 | Ashley Jennifer Ennedy | Preventive Medicine | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2017-12-19 |
| 1265979744 | Hossein Manavizadeh | Pharmacist | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2017-01-23 |
| 1821533985 | Jessica Llamas | Specialist/Technologist | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2016-12-28 |
| 1770946543 | Jill M. Lundstrom | Pediatrics | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2016-03-30 |
| 1447610571 | Christina N Nakashima | Pharmacist | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2016-03-02 |
| 1033578661 | Patricia Polikoff | Pharmacist | 10243 Genetic Center Dr, San Diego, CA 92121-6310 | 2016-02-10 |
| 1265859524 | Angela Sung | Psychiatry & Neurology | 10243 Genetic Center Dr, San Diego, CA 92121 | 2014-03-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225644917 | Anna Hand | Physical Therapist | 5945 Pacific Center Blvd Bldg #510, San Diego, CA 92121 | 2020-09-18 |
| 1972138030 | Lamarr Joyner | Licensed Vocational Nurse | 5930 Conerstone Court West, Suite 300, San Diego, CA 92121 | 2020-03-10 |
| 1396383212 | La Jolla Professional Plastic Surgery | Plastic Surgery | 4510 Executive Dr. Suite 105, San Diego, CA 92121 | 2019-12-11 |
| 1841852472 | Unmanned Systems Operations Group | Air Carrier | 4655 Executive Dr., Suite 700, San Diego, CA 92121 | 2019-07-03 |
| 1861051922 | Grace Getchell | Behavior Technician | 3978 Sorrento Valley Blvd. #100, San Diego, CA 92121 | 2019-06-11 |
| 1720643299 | Megan Jean Bathen | Behavior Technician | Cortica Behavioral Inc., 7090 Miratech Dr., San Diego, CA 92121 | 2019-05-09 |
| 1346804366 | Daniel Melita | Massage Therapist | 11689 Sorrento Valley Rd Ste Q, San Diego, CA 92121 | 2019-04-25 |
| 1831674464 | Stepahnie Becerra | Behavior Technician | 3978 Sorrento Valley Blvd Suite 100, San Diego, CA 92121 | 2018-09-28 |
| 1265915466 | Ailyn Martinez | Behavior Technician | 3978 Sorrento Valley Bldv, 100, San Diego, CA 92121 | 2018-09-13 |
| 1790265163 | Genben Lifesciences Corporation | Public Health or Welfare | 6370 Lusk Blvd Ste F205, San Diego, CA 92121 | 2018-08-15 |
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| Taxonomy Code | 207V00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Obstetrics & Gynecology |
| An obstetrician/gynecologist possesses special knowledge, skills and professional capability in the medical and surgical care of the female reproductive system and associated disorders. This physician serves as a consultant to other physicians and as a primary physician for women. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definiton added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Obstetrics and Gynecology, 2007. http://www.abog.org/. American Osteopathic Board of Obstetrics and Gynecology, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Obstetrics and Gynecology. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Obstetrics and Gynecology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316494768 | Samantha Berg | Obstetrics & Gynecology | 9339 Genesee Ave Ste 220, San Diego, CA 92121-2121 | 2016-09-01 |
| 1326495276 | Elizabeth Anne Coulter | Obstetrics & Gynecology | 200 West Arbor Drive, Mc8433, Ucsd Residency Office, San Diego, CA 92103 | 2016-05-20 |
| 1962889121 | Reproductive Sciences Medical Center | Obstetrics & Gynecology | 3661 Valley Centre Dr, Suite 100, San Diego, CA 92130-3321 | 2015-04-27 |
| 1134515695 | Tiffani Phan | Obstetrics & Gynecology | 550 Washington St Ste 331, San Diego, CA 92103-2227 | 2015-04-11 |
| 1437544251 | Lindsey Ann Burnett | Obstetrics & Gynecology | 200 West Arbor Drive, Mailcode 8433, University of California San Diego, San Diego, CA 92103 | 2015-03-30 |
| 1811240906 | Charles Hamrang | Obstetrics & Gynecology | 3250 Bunker Hill, San Diego, CA 92117 | 2012-10-26 |
| 1780955328 | Gerald M Spector | Obstetrics & Gynecology | 4045 Couts St, San Diego, CA 92103-1501 | 2012-01-12 |
| 1841578572 | L Dale Lapp M D Inc | Obstetrics & Gynecology | 4060 4th Ave Ste 640, San Diego, CA 92103-2118 | 2011-07-29 |
| 1114221603 | Leroy Albert Miller | Obstetrics & Gynecology | 2359 Juan Street, San Diego, CA 92103 | 2010-12-27 |
| 1154635415 | Robert J Santella, Md. Inc. | Obstetrics & Gynecology | 4531 College Ave, San Diego, CA 92115-4010 | 2010-07-28 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.