Healthcare Provider Details

I. General information

NPI: 1669200432
Provider Name (Legal Business Name): ELLA LOUISE NIEDERREITER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 07/23/2024
Certification Date: 07/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 E TULARE AVE
VISALIA CA
93292-3629
US

IV. Provider business mailing address

520 E TULARE AVE
VISALIA CA
93292-3629
US

V. Phone/Fax

Practice location:
  • Phone: 559-623-0900
  • Fax: 559-749-9823
Mailing address:
  • Phone: 559-623-0900
  • Fax: 559-749-9823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: