Provider Demographics
NPI:1568891851
Name:MESSIAH, MICHELE GAIL (PA)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:GAIL
Last Name:MESSIAH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:1050 INGRAHAM ST
Mailing Address - Street 2:334
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1989
Mailing Address - Country:US
Mailing Address - Phone:310-779-6660
Mailing Address - Fax:
Practice Address - Street 1:30839 E THOUSAND OAKS BLVD
Practice Address - Street 2:
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-4039
Practice Address - Country:US
Practice Address - Phone:310-402-4589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA23299363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical