Provider Demographics
NPI:1619178498
Name:TOBIN, MICHELLE
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:
Last Name:TOBIN
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 ACKERMAN LN
Mailing Address - Street 2:
Mailing Address - City:CARLOTTA
Mailing Address - State:CA
Mailing Address - Zip Code:95528-9648
Mailing Address - Country:US
Mailing Address - Phone:707-601-7595
Mailing Address - Fax:
Practice Address - Street 1:927 MAIN ST
Practice Address - Street 2:
Practice Address - City:FORTUNA
Practice Address - State:CA
Practice Address - Zip Code:95540-2006
Practice Address - Country:US
Practice Address - Phone:707-601-7595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14768171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
No171100000XOther Service ProvidersAcupuncturist