Individual
MICHAEL JOHN MICHAELIDES JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
679 S NEW HAMPSHIRE AVE STE 400, LOS ANGELES, CA 90005-1355
(213) 639-2500
Mailing address
679 S NEW HAMPSHIRE AVE STE 400, LOS ANGELES, CA 90005-1355
(213) 639-2500
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
LPT42462
CA
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
08/07/2012
Last updated
02/28/2023
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