Provider Demographics
NPI:1447878095
Name:LABAO, MICHELLE VALDEZ (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:VALDEZ
Last Name:LABAO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:VALDEZ
Other - Last Name:LABAO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AGACNP-BC
Mailing Address - Street 1:PO BOX 703
Mailing Address - Street 2:
Mailing Address - City:DUARTE
Mailing Address - State:CA
Mailing Address - Zip Code:91009-0703
Mailing Address - Country:US
Mailing Address - Phone:626-252-0994
Mailing Address - Fax:
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6098
Practice Address - Country:US
Practice Address - Phone:213-413-3000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95014837363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care