Healthcare Provider Details

I. General information

NPI: 1558209197
Provider Name (Legal Business Name): MICHELLE COLLEOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 N 2ND AVE
BARSTOW CA
92311-2226
US

IV. Provider business mailing address

1237 CABRILLO DR
BARSTOW CA
92311-6710
US

V. Phone/Fax

Practice location:
  • Phone: 760-255-1872
  • Fax:
Mailing address:
  • Phone: 760-255-1872
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: