Healthcare Provider Details

I. General information

NPI: 1225481427
Provider Name (Legal Business Name): MICHAEL PARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 W MISSION ST
SAN JOSE CA
95110-1713
US

IV. Provider business mailing address

151 W MISSION ST
SAN JOSE CA
95110-1713
US

V. Phone/Fax

Practice location:
  • Phone: 408-535-4004
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License NumberC28021214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: