Healthcare Provider Details

I. General information

NPI: 1326163502
Provider Name (Legal Business Name): DN MICHELSON, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 SOUTH A STREET SUITE 300
OXNARD CA
93030
US

IV. Provider business mailing address

200 S A ST SUITE 300
OXNARD CA
93030-5717
US

V. Phone/Fax

Practice location:
  • Phone: 805-486-1356
  • Fax: 805-486-8206
Mailing address:
  • Phone: 805-486-1966
  • Fax: 805-486-8206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberG31906
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID N. MICHELSON
Title or Position: PRESIDENT
Credential: MEDICAL DOCTOR
Phone: 805-495-6411