Provider Demographics
NPI:1144499534
Name:DIIORIO, MICHAELEN (PA)
Entity type:Individual
Prefix:
First Name:MICHAELEN
Middle Name:
Last Name:DIIORIO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13425 INGLEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:HAWTHORNE
Mailing Address - State:CA
Mailing Address - Zip Code:90250-5608
Mailing Address - Country:US
Mailing Address - Phone:310-679-2201
Mailing Address - Fax:310-679-4236
Practice Address - Street 1:13425 INGLEWOOD AVE
Practice Address - Street 2:
Practice Address - City:HAWTHORNE
Practice Address - State:CA
Practice Address - Zip Code:90250-5608
Practice Address - Country:US
Practice Address - Phone:310-679-2201
Practice Address - Fax:310-679-4236
Is Sole Proprietor?:No
Enumeration Date:2008-02-29
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant