Healthcare Provider Details

I. General information

NPI: 1154771590
Provider Name (Legal Business Name): MICHON AFFINITO PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2016
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 TRUXTUN RD FL 2
SAN DIEGO CA
92106-6125
US

IV. Provider business mailing address

5350 BALTIMORE DR UNIT 53
LA MESA CA
91942-4618
US

V. Phone/Fax

Practice location:
  • Phone: 775-813-0864
  • Fax:
Mailing address:
  • Phone: 775-813-0864
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: