Healthcare Provider Details

I. General information

NPI: 1336700285
Provider Name (Legal Business Name): MICHELLE C MEZIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE C ZENS

II. Dates (important events)

Enumeration Date: 06/21/2019
Last Update Date: 07/21/2021
Certification Date: 07/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30100 TOWN CENTER DRIVE SUITE YZ
LAGUNA NIGUEL CA
92677-1250
US

IV. Provider business mailing address

23521 PASEO DE VALENCIA SUITE B7
LAGUNA HILLS CA
92653-2843
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-5401
  • Fax: 949-276-5403
Mailing address:
  • Phone: 949-597-0007
  • Fax: 948-597-0040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License NumberPT296766
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: