Provider Demographics
NPI:1205653136
Name:LEHDE, MICHELLE DOLORES
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DOLORES
Last Name:LEHDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19723 FALCON CIR
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-7714
Mailing Address - Country:US
Mailing Address - Phone:562-251-7850
Mailing Address - Fax:
Practice Address - Street 1:21505 NORWALK BLVD
Practice Address - Street 2:
Practice Address - City:HAWAIIAN GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90716-1121
Practice Address - Country:US
Practice Address - Phone:562-916-7581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA722435164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse