JUSTIN THOMAS DIEDRICH MD Medical Doctor License verification

Business Entity

ACTIVE

License Type

Medical Doctor

Description

LICENSED PHYSICIAN CONTROLLED SUBSTANCE

License Number

33*****47

License Status

ACTIVE

Business

Title

First Name

JUSTIN

Middle

THOMAS

Last Name

DIEDRICH

Business Name

JUSTIN THOMAS DIEDRICH MD

Original Issue Date

02/15/2018

Effective Date

04/24/2023

Expiration Date

07/31/2026

City

PASADENA

State

Zip

91101

Specialty/Qualifier

PRACTITIONER

Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

04/24/2023