Provider Demographics
NPI:1154771590
Name:AFFINITO, MICHON (PPS)
Entity type:Individual
Prefix:
First Name:MICHON
Middle Name:
Last Name:AFFINITO
Suffix:
Gender:F
Credentials:PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 BALTIMORE DR UNIT 53
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-4618
Mailing Address - Country:US
Mailing Address - Phone:775-813-0864
Mailing Address - Fax:
Practice Address - Street 1:2230 TRUXTUN RD FL 2
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-6125
Practice Address - Country:US
Practice Address - Phone:775-813-0864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-16
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW416Medicare PIN