Provider Demographics
NPI:1952479339
Name:HENRY, MICHELLE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:HENRY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:21021 TOMLEE AVE
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-4064
Mailing Address - Country:US
Mailing Address - Phone:310-818-1989
Mailing Address - Fax:213-742-5731
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-742-5716
Practice Address - Fax:213-742-5731
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG740472080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G740470Medicaid