Healthcare Provider Details

I. General information

NPI: 1720920283
Provider Name (Legal Business Name): MICHAELA DUBOIS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2026
Last Update Date: 04/06/2026
Certification Date: 03/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR #0304
SAN DIEGO CA
92103-1911
US

IV. Provider business mailing address

409 COMBS CT
MARINA CA
93933-5009
US

V. Phone/Fax

Practice location:
  • Phone: 805-402-3705
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: