Healthcare Provider Details

I. General information

NPI: 1851358022
Provider Name (Legal Business Name): MICHELLE A LOFTIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 ALTSCHUL AVE
MENLO PARK CA
94025-6603
US

IV. Provider business mailing address

325 SHARON PARK DR # 421
MENLO PARK CA
94025-6805
US

V. Phone/Fax

Practice location:
  • Phone: 408-664-6816
  • Fax:
Mailing address:
  • Phone: 408-664-6816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA66222
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: