Provider Demographics
NPI:1073144010
Name:RAMIREZ, MELISSA ALEXIS
Entity Type:Individual
Prefix:MISS
First Name:MELISSA
Middle Name:ALEXIS
Last Name:RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3604 BEYER BLVD APT 36-203
Mailing Address - Street 2:
Mailing Address - City:SAN YSIDRO
Mailing Address - State:CA
Mailing Address - Zip Code:92173-1976
Mailing Address - Country:US
Mailing Address - Phone:619-836-2366
Mailing Address - Fax:
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3763
Practice Address - Country:US
Practice Address - Phone:619-782-0700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-29
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TC2200X
CARBT-22-210218106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680317191OtherMEDCAL
CA9611740AAOtherMEDICAL