MEDICARE: MICHELLE GUISELINI BARON CMT

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	225700000X	Massage Therapist	18684	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18684	OTHER	CA	CA MASSAGE THERAPY COUNCIL

General Provider Information

NPI Number	:	1700432150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE GUISELINI BARON CMT

Provider Business Mailing Address
First Line	:	539 N WINDSOR BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1412
Country	:	US
Telephone Number	:	323-378-6593
Fax Number	:

Provider Business Practice Location Address
First Line	:	539 N WINDSOR BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1412
Country	:	US
Telephone Number	:	323-378-6593
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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