Healthcare Provider Details

I. General information

NPI: 1619178498
Provider Name (Legal Business Name): MS. MICHELLE TOBIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 09/11/2025
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 MAIN ST
FORTUNA CA
95540-2006
US

IV. Provider business mailing address

219 ACKERMAN LN
CARLOTTA CA
95528-9648
US

V. Phone/Fax

Practice location:
  • Phone: 707-601-7595
  • Fax:
Mailing address:
  • Phone: 707-601-7595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC14768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: