Active NPI
Jennifer Leala Dietzen
- Clinical Social Worker
- San Diego, CA
National Provider Identifier
1851933683
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 121129
- Practice address
- 3148 Midway Dr
San Diego, CA 92110-4539 - Phone
- (619) 363-0853
- NPI assigned
- Oct 14, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Counselor | 101Y00000X | |||
| Mental Health Counselor | 101YM0800X | 121129 | CA | |
| Clinical Social Worker | 1041C0700X | 121129 | CA | Primary |
Addresses
Primary practice location
3148 Midway Dr
San Diego, CA 92110-4539
Mailing address
3148 Midway Dr Ste 113
San Diego, CA 92110-4539
Phone (619) 363-0853
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 |
|---|---|---|---|
| 121129 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1571011200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1750636800000",
"number": "1851933683",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3148 MIDWAY DR STE 113",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104539",
"telephone_number": "619-363-0853"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3148 MIDWAY DR",
"city": "SAN DIEGO",
"state": "CA",
"postal_code": "921104539",
"telephone_number": "619-363-0853"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DIETZEN",
"first_name": "JENNIFER",
"middle_name": "LEALA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-10-14",
"last_updated": "2025-06-23",
"certification_date": "2025-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "CA",
"license": "121129",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CA",
"license": "121129",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Diego, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.