Healthcare Provider Details

I. General information

NPI: 1508027194
Provider Name (Legal Business Name): MICHELLE L IKEI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1175 SARATOGA AVE STE 14
SAN JOSE CA
95129-3427
US

IV. Provider business mailing address

1175 SARATOGA AVE STE 14
SAN JOSE CA
95129-3427
US

V. Phone/Fax

Practice location:
  • Phone: 408-996-7950
  • Fax:
Mailing address:
  • Phone: 408-996-7950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number56364
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number51768
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: