Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A8595 | CA |
N | 207Q00000X | Family Doctor | 20A8595 | CA |
N | 208D00000X | General Practice Physician | 20A8595 | CA |
N | 225700000X | Massage Therapist |
NPI | 1598834244 |
---|---|
Provider Name | Dr. Michelle F Veneziano |
First Address | San Rafael, CA 94901-2699 |
Second Address | Mill Valley, CA 94941-3034 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2006 |
Last Update Date | 26/12/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
445248 | (05) | CA |
H49531 | (02) | CA |