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NPI Code Detail

MEDICARE: MICHA BIETZ

MEDICARE: MICHA BIETZ
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
11041C0700XClinical Social Worker123571CA

General Provider Information

NPI Number : 1114744273
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHA BIETZ
Provider Business Mailing Address
First Line : 9125 SOUTHERN RD
Second Line :
City : LA MESA
State : CA
Zip : 91942-3609
Country : US
Telephone Number : 619-987-0134
Fax Number :
Provider Business Practice Location Address
First Line : 12396 WORLD TRADE DR STE 204
Second Line :
City : SAN DIEGO
State : CA
Zip : 92128-3789
Country : US
Telephone Number : 858-768-8737
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2024
Last Update Date : 09/20/2024

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Directions to “ MICHA BIETZ ” Practice Location

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