Provider Demographics
NPI:1679823504
Name:PINA, MELISSA JANE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:PINA
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 1:3700 DELTA FAIR BLVD
Mailing Address - Street 2:SUITE 201A
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-4019
Mailing Address - Country:US
Mailing Address - Phone:925-586-6407
Mailing Address - Fax:
Practice Address - Street 1:707 KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5515
Practice Address - Country:US
Practice Address - Phone:925-699-4160
Practice Address - Fax:925-699-4160
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-18
Last Update Date:2017-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20165235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist