MICHAEL TIIDEBERG NPI 1538644521

NPI Information

NPI: 1538644521
Provider Name: MICHAEL TIIDEBERG
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Individual

Specialization: Family

PECOS Registration: Yes

Address:
31630 RAILROAD CANYON RD STE 4
CANYON LAKE, CA
ZIP 92587
Phone: (951) 837-6980
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Michael Tiideberg is a family nurse practitioner in Canyon Lake, CA with 8 years of experience. Michael Tiideberg NPI is 1538644521. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

31630 RAILROAD CANYON RD STE 4
CANYON LAKE, CA
ZIP 92587-478
Phone: (951) 837-6980

The NPI 1538644521 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/26/2018 and was last updated on 7/25/2022.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family	95009382	CALIFORNIA	Yes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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