Provider Demographics
NPI:1972188472
Name:MACDONALD, MICHAELA (CYT)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:CYT
Other - Prefix:
Other - First Name:KALA
Other - Middle Name:
Other - Last Name:MACDONALD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CYT
Mailing Address - Street 1:17630 RHODA ST
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1255
Mailing Address - Country:US
Mailing Address - Phone:816-805-6614
Mailing Address - Fax:
Practice Address - Street 1:17630 RHODA ST
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1255
Practice Address - Country:US
Practice Address - Phone:816-805-6614
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula