Healthcare Provider Details

I. General information

NPI: 1487347506
Provider Name (Legal Business Name): MICHELLE KEZELI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

165 CLAY ST
SALINAS CA
93901-2509
US

IV. Provider business mailing address

130 W GABILAN ST
SALINAS CA
93901-2762
US

V. Phone/Fax

Practice location:
  • Phone: 831-422-6226
  • Fax: 831-422-6296
Mailing address:
  • Phone: 831-758-0181
  • Fax: 831-758-5127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberSUDRC15485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: