Provider Demographics
NPI:1578173969
Name:SALAZAR, MELYSSA ERIANNA
Entity Type:Individual
Prefix:
First Name:MELYSSA
Middle Name:ERIANNA
Last Name:SALAZAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELYSSA
Other - Middle Name:ERIANNA
Other - Last Name:PRADO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3197B MINUTEMAN WAY # B
Mailing Address - Street 2:
Mailing Address - City:HILL AFB
Mailing Address - State:UT
Mailing Address - Zip Code:84056-1657
Mailing Address - Country:US
Mailing Address - Phone:626-366-7984
Mailing Address - Fax:
Practice Address - Street 1:3197B MINUTEMAN WAY # B
Practice Address - Street 2:
Practice Address - City:HILL AFB
Practice Address - State:UT
Practice Address - Zip Code:84056-1657
Practice Address - Country:US
Practice Address - Phone:626-366-7984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-31
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician