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General NPI Number Information
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NPI Number | 1639967383
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Entity Type | Individual
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Provider Name | ETHAN STIFFELMAN
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Gender |
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Dates
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Enumeration Date | 04/30/2025
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Last Update Date | 08/13/2025
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Provider Practice Location Address
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Address Line | 17555 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-3890
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Country | US
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Telephone | 818-305-1952
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Fax |
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Provider Business Mailing Address
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Address Line | 17555 VENTURA BLVD
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City | ENCINO
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State | CA
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Zip | 91316-3890
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Country | US
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Telephone |
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 25-QMHS-I-00137
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License Number State | CA
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