MEDICARE: MRS. MICHELLE MAYBERRY LOPILATO

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	81936	CA

General Provider Information

NPI Number	:	1922758994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MICHELLE MAYBERRY LOPILATO

Provider Business Mailing Address
First Line	:	1613 E WASHINGTON AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-3249
Country	:	US
Telephone Number	:	714-353-5746
Fax Number	:

Provider Business Practice Location Address
First Line	:	1613 E WASHINGTON AVE
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92701-3249
Country	:	US
Telephone Number	:	714-353-5746
Fax Number	:

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

Provider Enumeration Date	:	03/24/2022
Last Update Date	:	03/24/2022

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