Healthcare Provider Details

I. General information

NPI: 1598940926
Provider Name (Legal Business Name): MICHAEL MCDONALD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 PEARL ST
MONTEREY CA
93940-3070
US

IV. Provider business mailing address

650 SLOAT AVE APT 12
MONTEREY CA
93940-3650
US

V. Phone/Fax

Practice location:
  • Phone: 831-649-4522
  • Fax:
Mailing address:
  • Phone: 831-207-9709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberMFC35946
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: