Provider Demographics
NPI:1578924015
Name:DN MICHELSON MD INC.
Entity Type:Organization
Organization Name:DN MICHELSON MD INC.
Other - Org Name:COSMETIC, AESTHETIC AND ANTI-AGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:MICHELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-485-3888
Mailing Address - Street 1:1889 N RICE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-7270
Mailing Address - Country:US
Mailing Address - Phone:805-485-3888
Mailing Address - Fax:805-485-5810
Practice Address - Street 1:1889 N RICE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7270
Practice Address - Country:US
Practice Address - Phone:805-485-3888
Practice Address - Fax:805-485-5810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31906261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical