Provider Demographics
NPI:1508622572
Name:MICHAELIAN, SOLEIL MARIE
Entity Type:Individual
Prefix:
First Name:SOLEIL
Middle Name:MARIE
Last Name:MICHAELIAN
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 1:219 VIA KORON
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4912
Mailing Address - Country:US
Mailing Address - Phone:949-244-2034
Mailing Address - Fax:
Practice Address - Street 1:219 VIA KORON
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4912
Practice Address - Country:US
Practice Address - Phone:949-244-2034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician