Healthcare Provider Details

I. General information

NPI: 1861696734
Provider Name (Legal Business Name): MICHELLE DEANNA HEALY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W CARSON ST BOX 17
TORRANCE CA
90502-2004
US

IV. Provider business mailing address

16700 YUKON AVE # 107
TORRANCE CA
90504-1300
US

V. Phone/Fax

Practice location:
  • Phone: 310-222-2301
  • Fax:
Mailing address:
  • Phone: 310-701-2026
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG75554
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: