Provider Demographics
NPI:1710615067
Name:GARRIDO, MELISSA ROSE
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ROSE
Last Name:GARRIDO
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 1:4917 SW 25TH CT
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6614
Mailing Address - Country:US
Mailing Address - Phone:786-202-5281
Mailing Address - Fax:
Practice Address - Street 1:4917 SW 25TH CT
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6614
Practice Address - Country:US
Practice Address - Phone:786-202-5281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty