Provider Demographics
NPI:1518608637
Name:MELENDEZ-GOMEZ, DANIELLA MARINA (SUDCR #13092)
Entity Type:Individual
Prefix:
First Name:DANIELLA
Middle Name:MARINA
Last Name:MELENDEZ-GOMEZ
Suffix:
Gender:F
Credentials:SUDCR #13092
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42500 ROAD 64
Mailing Address - Street 2:
Mailing Address - City:DINUBA
Mailing Address - State:CA
Mailing Address - Zip Code:93618-9137
Mailing Address - Country:US
Mailing Address - Phone:805-280-3221
Mailing Address - Fax:
Practice Address - Street 1:2550 W CLINTON AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93705-4206
Practice Address - Country:US
Practice Address - Phone:559-365-9665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-05
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty