Healthcare Provider Details

I. General information

NPI: 1003327396
Provider Name (Legal Business Name): MICHELLE HOBSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 03/05/2020
Certification Date: 03/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7929
US

IV. Provider business mailing address

20452 BAYVIEW AVE
NEWPORT BEACH CA
92660-0710
US

V. Phone/Fax

Practice location:
  • Phone: 949-386-2656
  • Fax:
Mailing address:
  • Phone: 949-433-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number102420
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: