Provider Demographics
NPI:1376214205
Name:MELGOZA, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:MELGOZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1531 LINDAUER DR
Mailing Address - Street 2:
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-2520
Mailing Address - Country:US
Mailing Address - Phone:714-499-4289
Mailing Address - Fax:
Practice Address - Street 1:1531 LINDAUER DR
Practice Address - Street 2:
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-2520
Practice Address - Country:US
Practice Address - Phone:714-499-4289
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician