Basic Information
| Provider Information | |||||||||
| NPI: | 1245794486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FELIX | ||||||||
| FirstName: | MICHELLE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8885 RIO SAN DIEGO DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197959925 | ||||||||
| FaxNumber: | 8776025087 | ||||||||
| Practice Location | |||||||||
| Address1: | 8885 RIO SAN DIEGO DR STE 340 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081669 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197959925 | ||||||||
| FaxNumber: | 8776025087 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/22/2019 | ||||||||
| LastUpdateDate: | 01/23/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-18-33619 | CA | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.