Provider Demographics
NPI:1700432150
Name:BARON, MICHELLE GUISELINI (CMT)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:GUISELINI
Last Name:BARON
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 N WINDSOR BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90004-1412
Mailing Address - Country:US
Mailing Address - Phone:323-378-6593
Mailing Address - Fax:
Practice Address - Street 1:539 N WINDSOR BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90004-1412
Practice Address - Country:US
Practice Address - Phone:323-378-6593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-12
Last Update Date:2019-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18684225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18684OtherCA MASSAGE THERAPY COUNCIL