Healthcare Provider Details

I. General information

NPI: 1013732890
Provider Name (Legal Business Name): MICHAEL HELLERUD MS, PPS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/18/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 SENECA PARK AVE
FREMONT CA
94538-4028
US

IV. Provider business mailing address

4455 SENECA PARK AVE
FREMONT CA
94538-4028
US

V. Phone/Fax

Practice location:
  • Phone: 510-657-9155
  • Fax:
Mailing address:
  • Phone: 510-657-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number220119718
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: