Provider Demographics
NPI:1619312535
Name:MICHAIL, NADINE JOSEPHINE (LAC)
Entity Type:Individual
Prefix:
First Name:NADINE
Middle Name:JOSEPHINE
Last Name:MICHAIL
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22345 S SUMMIT RIDGE CIR
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-2695
Mailing Address - Country:US
Mailing Address - Phone:818-317-1207
Mailing Address - Fax:
Practice Address - Street 1:22345 S SUMMIT RIDGE CIR
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2695
Practice Address - Country:US
Practice Address - Phone:818-317-1207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-06
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15154171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist