Provider Demographics
NPI:1710925623
Name:DEMITRI, MICHELLE FARADAY (NP)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:FARADAY
Last Name:DEMITRI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:FLEUR
Other - Last Name:FARADAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:950 S GRAND AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90015-3999
Mailing Address - Country:US
Mailing Address - Phone:323-669-4346
Mailing Address - Fax:323-635-1891
Practice Address - Street 1:150 N RENO ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-4656
Practice Address - Country:US
Practice Address - Phone:213-380-7298
Practice Address - Fax:213-385-1123
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14546363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily