Healthcare Provider Details

I. General information

NPI: 1962021030
Provider Name (Legal Business Name): MICHELLE FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2020
Last Update Date: 12/31/2024
Certification Date: 12/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2055 N PERRIS BLVD # C
PERRIS CA
92571-2509
US

IV. Provider business mailing address

25371 MOORLAND RD
MORENO VALLEY CA
92551-9278
US

V. Phone/Fax

Practice location:
  • Phone: 951-715-5050
  • Fax: 951-784-4986
Mailing address:
  • Phone: 951-355-3260
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: