Provider Demographics
NPI:1043252786
Name:PELLE, MICHELLE TEREZ (MD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:TEREZ
Last Name:PELLE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3965 5TH AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3107
Mailing Address - Country:US
Mailing Address - Phone:619-542-0013
Mailing Address - Fax:619-542-0559
Practice Address - Street 1:3965 5TH AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3107
Practice Address - Country:US
Practice Address - Phone:619-542-0013
Practice Address - Fax:619-542-0559
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88009207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A880090Medicaid
CAW19891Medicare PIN
CA00A880090Medicaid