Healthcare Provider Details

I. General information

NPI: 1801617071
Provider Name (Legal Business Name): MICHELLE FELICIANO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2024
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11776 MARIPOSA RD
HESPERIA CA
92345-1622
US

IV. Provider business mailing address

11776 MARIPOSA RD
HESPERIA CA
92345-1622
US

V. Phone/Fax

Practice location:
  • Phone: 661-416-7257
  • Fax:
Mailing address:
  • Phone: 661-416-7257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1478720822
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: