Provider Demographics
NPI:1831241066
Name:RECORD, MICHELLE RENEE (MD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:RECORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:RECORD
Other - Last Name:CONTINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6489 CAMDEN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2849
Mailing Address - Country:US
Mailing Address - Phone:408-268-1122
Mailing Address - Fax:408-268-5215
Practice Address - Street 1:6489 CAMDEN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2849
Practice Address - Country:US
Practice Address - Phone:408-268-1122
Practice Address - Fax:408-268-5215
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62447208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A624470Medicaid
H18148Medicare UPIN
00A624470Medicare ID - Type Unspecified