Provider Demographics
NPI:1407095219
Name:OGG, MELINDA GRACE (PHD)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:GRACE
Last Name:OGG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7177 BROCKTON AVE
Mailing Address - Street 2:SUITE 114
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2631
Mailing Address - Country:US
Mailing Address - Phone:951-276-1644
Mailing Address - Fax:951-534-0415
Practice Address - Street 1:7177 BROCKTON AVE.
Practice Address - Street 2:SUITE 114
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3122
Practice Address - Country:US
Practice Address - Phone:951-276-1644
Practice Address - Fax:951-534-0415
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16436103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical