Provider Demographics
NPI:1487319786
Name:DIETZ ROBERTS, KEREN ARLENE (PMHNP)
Entity type:Individual
Prefix:DR
First Name:KEREN
Middle Name:ARLENE
Last Name:DIETZ ROBERTS
Suffix:
Gender:
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2970 CAMINO DIABLO STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-4001
Mailing Address - Country:US
Mailing Address - Phone:925-282-1778
Mailing Address - Fax:
Practice Address - Street 1:2970 CAMINO DIABLO STE 300
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94597-4001
Practice Address - Country:US
Practice Address - Phone:925-282-1778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-02
Last Update Date:2025-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4710765163W00000X
CA95267120163W00000X
CA95029421363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse