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NPI Code Detail

MEDICARE: MICHELLE ANDERSON

MEDICARE: MICHELLE ANDERSON
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
1225700000XMassage Therapist

General Provider Information

NPI Number : 1932694213
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHELLE ANDERSON
Provider Business Mailing Address
First Line : 863 TEMPLE TER
Second Line :
City : LOS ANGELES
State : CA
Zip : 90042-5022
Country : US
Telephone Number : 213-500-8051
Fax Number :
Provider Business Practice Location Address
First Line : 3460 OCEAN VIEW BLVD STE B
Second Line :
City : GLENDALE
State : CA
Zip : 91208-3306
Country : US
Telephone Number : 213-500-8051
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/28/2018
Last Update Date : 06/28/2018

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Directions to “ MICHELLE ANDERSON ” Practice Location

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