Provider Demographics
NPI:1457672503
Name:VIRRUETA, MELISSA ITZEL
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ITZEL
Last Name:VIRRUETA
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:PO BOX 145
Mailing Address - Street 2:
Mailing Address - City:PROBERTA
Mailing Address - State:CA
Mailing Address - Zip Code:96078-0145
Mailing Address - Country:US
Mailing Address - Phone:530-304-3551
Mailing Address - Fax:
Practice Address - Street 1:2550 FLORAL AVE
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-9143
Practice Address - Country:US
Practice Address - Phone:530-893-4784
Practice Address - Fax:530-893-6144
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health