MEDICARE: MICHELLE KATHLEEN MALLOY LAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist	19636	CA

General Provider Information

NPI Number	:	1033822911
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE KATHLEEN MALLOY LAC

Provider Business Mailing Address
First Line	:	428 S ROBERTSON BLVD APT 503
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-3287
Country	:	US
Telephone Number	:	310-504-3077
Fax Number	:

Provider Business Practice Location Address
First Line	:	7223 BEVERLY BLVD STE 202
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-2500
Country	:	US
Telephone Number	:	310-504-3077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2023
Last Update Date	:	12/09/2025

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