Healthcare Provider Details

I. General information

NPI: 1205653136
Provider Name (Legal Business Name): MICHELLE DOLORES LEHDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2024
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21505 NORWALK BLVD
HAWAIIAN GARDENS CA
90716-1121
US

IV. Provider business mailing address

19723 FALCON CIR
CERRITOS CA
90703-7714
US

V. Phone/Fax

Practice location:
  • Phone: 562-916-7581
  • Fax:
Mailing address:
  • Phone: 562-251-7850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number722435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: