Healthcare Provider Details

I. General information

NPI: 1902571870
Provider Name (Legal Business Name): MICHAEL ANDREW LEGASPI
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N 4TH ST
SAN JOSE CA
95112-5569
US

IV. Provider business mailing address

877 TASSASARA DR
MILPITAS CA
95035-4535
US

V. Phone/Fax

Practice location:
  • Phone: 408-750-4499
  • Fax: 408-550-7433
Mailing address:
  • Phone: 408-750-4499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: