Provider Demographics
NPI:1700487766
Name:PADRE, MICHELLE DE VELA (AGACNP-BC, AGCNS, RN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:DE VELA
Last Name:PADRE
Suffix:
Gender:F
Credentials:AGACNP-BC, AGCNS, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19305 HALLMARK LN
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6841
Mailing Address - Country:US
Mailing Address - Phone:562-316-8487
Mailing Address - Fax:
Practice Address - Street 1:46 PENINSULA CTR STE E
Practice Address - Street 2:#303
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3562
Practice Address - Country:US
Practice Address - Phone:310-994-5679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA843396163W00000X
CA4892364SA2100X
CA95015659363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care