MEDICARE: MRS. MICHELLE ZIDES PPS

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	101YS0200X	School Counselor		CA

General Provider Information

NPI Number	:	1669319869
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE ZIDES PPS

Provider Business Mailing Address
First Line	:	33333 GOLDEN LANTERN
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-1899
Country	:	US
Telephone Number	:	949-496-6666
Fax Number	:

Provider Business Practice Location Address
First Line	:	33333 GOLDEN LANTERN
Second Line	:
City	:	DANA POINT
State	:	CA
Zip	:	92629-1899
Country	:	US
Telephone Number	:	949-496-6666
Fax Number	:

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

Provider Enumeration Date	:	05/04/2026
Last Update Date	:	05/04/2026

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