Provider Demographics
NPI:1760727150
Name:SIAZON, MICHELLE JOY (LAC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JOY
Last Name:SIAZON
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 1:10203 MOORPARK ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91978
Mailing Address - Country:US
Mailing Address - Phone:619-971-6424
Mailing Address - Fax:
Practice Address - Street 1:10203 MOORPARK ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91978
Practice Address - Country:US
Practice Address - Phone:619-971-6424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC14216171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist