Provider Demographics
NPI:1700425832
Name:HALOOSSIM, MICHELLE RACHEL (DACM, MPH, LAC)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:RACHEL
Last Name:HALOOSSIM
Suffix:
Gender:F
Credentials:DACM, MPH, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1122 MAYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-2735
Mailing Address - Country:US
Mailing Address - Phone:310-429-2711
Mailing Address - Fax:
Practice Address - Street 1:1122 MAYBROOK DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-2735
Practice Address - Country:US
Practice Address - Phone:310-429-2711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18427171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist