Provider Demographics
NPI:1568644656
Name:SUAREZ, MELINA (MFC)
Entity Type:Individual
Prefix:
First Name:MELINA
Middle Name:
Last Name:SUAREZ
Suffix:
Gender:F
Credentials:MFC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3517 CAMINO DEL RIO S STE 215
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-4098
Mailing Address - Country:US
Mailing Address - Phone:619-584-5777
Mailing Address - Fax:619-584-5760
Practice Address - Street 1:3517 CAMINO DEL RIO S STE 215
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4098
Practice Address - Country:US
Practice Address - Phone:619-584-5777
Practice Address - Fax:619-584-5760
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-29
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA44273OtherBBS