Provider Demographics
NPI:1790311470
Name:DAVID, MELANIE S (MA)
Entity Type:Individual
Prefix:
First Name:MELANIE
Middle Name:S
Last Name:DAVID
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1471 MEADOWCREST CIR
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-6080
Mailing Address - Country:US
Mailing Address - Phone:951-741-5087
Mailing Address - Fax:
Practice Address - Street 1:11498 PIERCE ST STE A&B
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3357
Practice Address - Country:US
Practice Address - Phone:951-785-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAPCC6642101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health