Healthcare Provider Details

I. General information

NPI: 1295853489
Provider Name (Legal Business Name): NDIDIAMAKA DILLIBE MATTHEWS D.P.T, N.C.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 07/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

582 ELDORA RD
PASADENA CA
91104-3613
US

IV. Provider business mailing address

582 ELDORA RD
PASADENA CA
91104-3613
US

V. Phone/Fax

Practice location:
  • Phone: 213-924-4377
  • Fax: 323-224-7075
Mailing address:
  • Phone: 213-924-4377
  • Fax: 323-224-7075

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251N0400X
TaxonomyNeurology Physical Therapist
License NumberPT27434
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: