Healthcare Provider Details

I. General information

NPI: 1245386192
Provider Name (Legal Business Name): MICHELE LEON GIRARD LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHELLY GIRARD LM, CPM

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

496 RAINBOW AVE
LOS ANGELES CA
90065-3952
US

IV. Provider business mailing address

496 RAINBOW AVE
LOS ANGELES CA
90065-3952
US

V. Phone/Fax

Practice location:
  • Phone: 323-221-7822
  • Fax: 323-221-8889
Mailing address:
  • Phone: 323-221-7822
  • Fax: 323-221-8889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberLM 022
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: