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General NPI Number Information
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NPI Number | 1922230796
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Entity Type | Individual
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Provider Name | MICHAEL J. METICHECCHIA
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Gender | Male
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Dates
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Enumeration Date | 08/12/2009
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Last Update Date | 10/28/2025
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Provider Practice Location Address
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Address Line | 360 GRAND CYPRESS AVE STE 304
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City | PALMDALE
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State | CA
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Zip | 93551-3646
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Country | US
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Telephone | 661-723-3700
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Fax | 661-723-3799
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Provider Business Mailing Address
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Address Line | 360 GRAND CYPRESS AVE STE 304
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City | PALMDALE
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State | CA
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Zip | 93551-3646
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Country | US
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Telephone | 661-723-3700
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Fax | 661-723-3799
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | C46460
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 224P00000X
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Taxonomy Name | Prosthetist
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License Number | C46460
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 222Z00000X
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Taxonomy Name | Orthotist
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License Number | C46460
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License Number State | CA
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