Individual
MS. MICHELLE LATICIA FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5631 ADOBE FALLS RD UNIT B, SAN DIEGO, CA 92120-4656
(619) 382-5674
Mailing address
5631 ADOBE FALLS RD UNIT B, SAN DIEGO, CA 92120-4656
(619) 382-5674
Taxonomy
Speciality
Code
Description
License number
State
3747A0650X
Attendant Care Provider
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
B7131883
DRIVER LICENSE
CA
Enumeration date
06/19/2020
Last updated
06/19/2020
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