Healthcare Provider Details

I. General information

NPI: 1467449975
Provider Name (Legal Business Name): MICHELE RACHEAL BROAD NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2005
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24910 LAS BRISAS ROAD STE 105
MURRIETA CA
92562-4010
US

IV. Provider business mailing address

6136 KETTLE FIRE TRL
COLORADO SPRINGS CO
80925-1351
US

V. Phone/Fax

Practice location:
  • Phone: 951-231-1385
  • Fax: 566-345-3272
Mailing address:
  • Phone: 951-533-6113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number428809
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number428809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: