Provider Demographics
NPI:1780976357
Name:MULVEY, MICHAEL FRANCIS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:FRANCIS
Last Name:MULVEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4725 HOEN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-9405
Mailing Address - Country:US
Mailing Address - Phone:707-542-1154
Mailing Address - Fax:707-542-4919
Practice Address - Street 1:4725 HOEN AVE STE B
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-9405
Practice Address - Country:US
Practice Address - Phone:707-542-1154
Practice Address - Fax:707-542-4919
Is Sole Proprietor?:No
Enumeration Date:2011-05-13
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 6092237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist