Healthcare Provider Details

I. General information

NPI: 1619830759
Provider Name (Legal Business Name): MRS. MICHELLE ANN DITOMASO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2377 SHERI PL
ALPINE CA
91901-4805
US

IV. Provider business mailing address

2377 SHERI PL
ALPINE CA
91901-4805
US

V. Phone/Fax

Practice location:
  • Phone: 619-933-6001
  • Fax:
Mailing address:
  • Phone: 619-933-6001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220071792
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: