Provider Demographics
NPI:1255805636
Name:REY, MICHELLE KAY (LM, CPM)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KAY
Last Name:REY
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 W PAMELA RD
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-4037
Mailing Address - Country:US
Mailing Address - Phone:909-510-9917
Mailing Address - Fax:626-587-4856
Practice Address - Street 1:420 ROLYN PL STE B
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-2839
Practice Address - Country:US
Practice Address - Phone:626-538-4813
Practice Address - Fax:626-587-4856
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA553176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife