Provider Demographics
NPI:1134638067
Name:WEBER, MICHAELA CHRISTINE (BS)
Entity type:Individual
Prefix:
First Name:MICHAELA
Middle Name:CHRISTINE
Last Name:WEBER
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:CHRISTINE
Other - Last Name:BERTOCCHINI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MICHAELA BERTOCCHINI
Mailing Address - Street 1:730 CORVEY CIR
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-3306
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3009 C ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3326
Practice Address - Country:US
Practice Address - Phone:916-442-2396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-22
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst