Healthcare Provider Details

I. General information

NPI: 1477522035
Provider Name (Legal Business Name): MICHELLE DONATO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2006
Last Update Date: 09/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 410
ORANGE CA
92868
US

IV. Provider business mailing address

1310 W STEWART DR STE 410
ORANGE CA
92868-3855
US

V. Phone/Fax

Practice location:
  • Phone: 714-639-9401
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number468117
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: