Healthcare Provider Details

I. General information

NPI: 1831241066
Provider Name (Legal Business Name): MICHELLE RENEE RECORD MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE RECORD CONTINI

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6489 CAMDEN AVE SUITE 102
SAN JOSE CA
95120-2849
US

IV. Provider business mailing address

6489 CAMDEN AVE SUITE 102
SAN JOSE CA
95120-2849
US

V. Phone/Fax

Practice location:
  • Phone: 408-268-1122
  • Fax: 408-268-5215
Mailing address:
  • Phone: 408-268-1122
  • Fax: 408-268-5215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA62447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: