Basic Information
| Provider Information | |||||||||
| NPI: | 1295872968 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIETZ | ||||||||
| FirstName: | SHARAI | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 6249 SKYWAY | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959694534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308723896 | ||||||||
| FaxNumber: | 5308724093 | ||||||||
| Practice Location | |||||||||
| Address1: | 6249 SKYWAY | ||||||||
| Address2: | |||||||||
| City: | PARADISE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959694534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5308723896 | ||||||||
| FaxNumber: | 5308724093 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2007 | ||||||||
| LastUpdateDate: | 04/30/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.