Healthcare Provider Details

I. General information

NPI: 1578490231
Provider Name (Legal Business Name): MR. MICHAEL D. TOLLEFSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33122 VALLE RD
SAN JUAN CAPISTRANO CA
92675-4859
US

IV. Provider business mailing address

33916 GOLDEN LANTERN APT B
DANA POINT CA
92629-2300
US

V. Phone/Fax

Practice location:
  • Phone: 949-234-9200
  • Fax: 949-493-8729
Mailing address:
  • Phone: 702-505-3060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number260112286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: