Provider Demographics
NPI:1528776440
Name:HELMS, MICHAEL ANTHONY
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:HELMS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:VAATX
Other - Middle Name:ANTHONY
Other - Last Name:HELMS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1640 BROADWAY APT 16
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5722
Mailing Address - Country:US
Mailing Address - Phone:602-477-9006
Mailing Address - Fax:
Practice Address - Street 1:3737 MORAGA AVE STE A204
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5489
Practice Address - Country:US
Practice Address - Phone:858-352-6438
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAL9776174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist