Provider Demographics
NPI:1396079562
Name:MICHEL, RICKY (NP)
Entity type:Individual
Prefix:
First Name:RICKY
Middle Name:
Last Name:MICHEL
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:RICK
Other - Middle Name:
Other - Last Name:MICHEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22 BUSHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-0513
Mailing Address - Country:US
Mailing Address - Phone:949-364-2641
Mailing Address - Fax:949-364-2641
Practice Address - Street 1:2615 CHESTER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-2014
Practice Address - Country:US
Practice Address - Phone:661-395-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-22
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF432455363L00000X
WY50590363L00000X
NM69968363L00000X
FLAPRN11009136363L00000X
TXAP107714363L00000X
IN28277195A363L00000X
KS53-82066-092363L00000X
ID73788363L00000X
OK210033363L00000X
MO2022034184363L00000X
CA652778(RN) 18010(NP)363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAP5706OtherMEDICAL LICENSE
AL1-073705OtherMEDICAL LICENSE