Active NPI
Roman Dietrich, PSY.D.
- Psychologist
- Stockton, CA
National Provider Identifier
1194857730
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 29575
- Practice address
- 7707 Austin Rd
Stockton, CA 95215-8312 - Phone
- (209) 467-3605
- NPI assigned
- Mar 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Psychologist | 103T00000X | 29575 | CA | Primary |
| Marriage & Family Therapist | 106H00000X | IMF 44745 | CA |
Addresses
Primary practice location
7707 Austin Rd
Stockton, CA 95215-8312
Mailing address
3994 Pinoche Peak Way
Rancho Cordova, CA 95742-7731
Phone (714) 309-8585
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 29575 | CA | MD | Psychologist |
| IMF 44745 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683072000000",
"number": "1194857730",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3994 PINOCHE PEAK WAY",
"city": "RANCHO CORDOVA",
"state": "CA",
"postal_code": "957427731",
"telephone_number": "714-309-8585"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7707 AUSTIN RD",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952158312",
"telephone_number": "209-467-3605"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETRICH",
"first_name": "ROMAN",
"credential": "PSY.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-09",
"last_updated": "2023-05-03",
"certification_date": "2023-05-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "29575",
"primary": true
},
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "IMF 44745",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.