Provider Demographics
NPI:1336700285
Name:MEZIN, MICHELLE C
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:MEZIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:C
Other - Last Name:ZENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23521 PASEO DE VALENCIA
Mailing Address - Street 2:SUITE B7
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-2843
Mailing Address - Country:US
Mailing Address - Phone:949-597-0007
Mailing Address - Fax:948-597-0040
Practice Address - Street 1:30100 TOWN CENTER DRIVE
Practice Address - Street 2:SUITE YZ
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1250
Practice Address - Country:US
Practice Address - Phone:949-276-5401
Practice Address - Fax:949-276-5403
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT296766225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT296766OtherPT LICENSE