MEDICARE: MICHELLE HACKBARDT CGC

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	170300000X	Genetic Counselor (M.S.)	GC000798	CA

General Provider Information

NPI Number	:	1861852675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE HACKBARDT CGC

Provider Business Mailing Address
First Line	:	1975 WOODLAND VALLEY GLN
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-3836
Country	:	US
Telephone Number	:	760-522-5681
Fax Number	:	714-456-5330

Provider Business Practice Location Address
First Line	:	1975 WOODLAND VALLEY GLN
Second Line	:
City	:	ESCONDIDO
State	:	CA
Zip	:	92026-3836
Country	:	US
Telephone Number	:	760-522-5681
Fax Number	:	714-456-5330

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

Provider Enumeration Date	:	03/07/2016
Last Update Date	:	06/10/2022

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