Provider Demographics
NPI:1376830406
Name:DO, MICHELLE
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:DO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:855 E BIRCH ST
Mailing Address - Street 2:T2482
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5769
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:855 E BIRCH ST
Practice Address - Street 2:T2482
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5769
Practice Address - Country:US
Practice Address - Phone:714-989-5014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-10
Last Update Date:2011-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61890183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist