Provider Demographics
NPI:1720588643
Name:MELCHOR, NEREIDA
Entity Type:Individual
Prefix:
First Name:NEREIDA
Middle Name:
Last Name:MELCHOR
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 1:8030 LA MESA BLVD STE 25
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-0335
Mailing Address - Country:US
Mailing Address - Phone:619-782-0700
Mailing Address - Fax:619-782-0710
Practice Address - Street 1:2667 CAMINO DEL RIO S STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3763
Practice Address - Country:US
Practice Address - Phone:619-782-0700
Practice Address - Fax:619-782-0710
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
CA1-21-48683103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-21-48683OtherBACB