MEDICARE: MICHELLE M CADAPAN

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	101Y00000X	Counselor
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1972736148
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE M CADAPAN

Provider Business Mailing Address
First Line	:	3132 JEFFERSON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1200
Country	:	US
Telephone Number	:	619-683-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3132 JEFFERSON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-1200
Country	:	US
Telephone Number	:	916-283-8280
Fax Number	:

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

Provider Enumeration Date	:	09/03/2009
Last Update Date	:	10/18/2010

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