Connor Deryl Dietz, MD, FRCPC

Primary specialty

Neurology PhysicianTaxonomy code 2084N0400X

License

A198459 Issued in CA

Practice address

675 Nelson Rising Lane
Suite 190
San Francisco, CA 94158

Phone

(415) 866-6835

NPI assigned

Aug 20, 2024

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1724112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724112000000",
    "number": "1780417493",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "675 NELSON RISING LANE",
            "address_2": "SUITE 190",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94158",
            "telephone_number": "415-866-6835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "675 NELSON RISING LANE",
            "address_2": "SUITE 190",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "94158",
            "telephone_number": "415-866-6835"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DIETZ",
        "first_name": "CONNOR",
        "middle_name": "DERYL",
        "name_prefix": "Dr.",
        "credential": "MD, FRCPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-08-20",
        "last_updated": "2024-08-20",
        "certification_date": "2024-08-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084B0040X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry",
            "state": "CA",
            "license": "A198459",
            "primary": false
        },
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "CA",
            "license": "A198459",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cameron Dietiker, M.D.
• Carol Dietrich, RN, LMFT, RDT
• Tara Ann Dietrick, R.N., C.R.N.A.
• Brett William Dietz
• Carly Rae Dietz, M.A.
• Lauren Dietz, RN
• Meghan Slemenda Dietz, D.P.T
• Tina K Dietz, PHD
• Adaney Diez
• Dig Deep, Inc

• Neurology Physician in San Francisco, CA
• Providers in San Francisco, CA by specialty
• Neurology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 20, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.