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General NPI Number Information
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NPI Number | 1316860984
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Entity Type | Individual
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Provider Name | MICHAEL NIDIFFER
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Gender | Male
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 625 S FAIR OAKS AVE STE 300
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City | PASADENA
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State | CA
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Zip | 91105-2672
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Country | US
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Telephone | 626-441-4221
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Fax |
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Provider Business Mailing Address
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Address Line | 3802 LUPINE LN APT D
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City | CALABASAS
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State | CA
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Zip | 91302-2920
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Country | US
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Telephone | 510-439-7375
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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