Healthcare Provider Details

I. General information

NPI: 1922230796
Provider Name (Legal Business Name): MICHAEL J. METICHECCHIA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2009
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 GRAND CYPRESS AVE STE 304
PALMDALE CA
93551-3646
US

IV. Provider business mailing address

360 GRAND CYPRESS AVE STE 304
PALMDALE CA
93551-3646
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-3700
  • Fax: 661-723-3799
Mailing address:
  • Phone: 661-723-3700
  • Fax: 661-723-3799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberC46460
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberC46460
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberC46460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: