Healthcare Provider Details

I. General information

NPI: 1609757871
Provider Name (Legal Business Name): NATHALIE DE MICHELIS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

101 THE CITY DRIVE SOUTH BLDG 53, SUITE 304-A
TUSTIN CA
92868
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8887
  • Fax: 714-456-2842
Mailing address:
  • Phone: 714-456-8887
  • Fax: 714-456-2842

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number501435
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: