Healthcare Provider Details

I. General information

NPI: 1376887232
Provider Name (Legal Business Name): ERIKA NIEDERNHOFER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2012
Last Update Date: 11/16/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 MANCHESTER AVE SUITE 103
ENCINITAS CA
92024-4938
US

IV. Provider business mailing address

4733 VISTA DE LA TIERRA
DEL MAR CA
92014-4220
US

V. Phone/Fax

Practice location:
  • Phone: 858-756-3021
  • Fax: 760-753-3405
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: