Provider Demographics
NPI:1043705957
Name:MARCOTTE, MICHELLE (LAC)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:MARCOTTE
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 AVOCADO AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-4638
Mailing Address - Country:US
Mailing Address - Phone:619-822-1330
Mailing Address - Fax:
Practice Address - Street 1:237 AVOCADO AVE STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-4638
Practice Address - Country:US
Practice Address - Phone:619-822-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-25
Last Update Date:2018-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC17438171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty