Provider Demographics
NPI:1790473189
Name:BAYSAL WALSH, MELDA INA
Entity Type:Individual
Prefix:
First Name:MELDA
Middle Name:INA
Last Name:BAYSAL WALSH
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 1:7840 MELOTTE ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-1238
Mailing Address - Country:US
Mailing Address - Phone:240-997-9403
Mailing Address - Fax:
Practice Address - Street 1:7840 MELOTTE ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1238
Practice Address - Country:US
Practice Address - Phone:240-997-9403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-25
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA121438101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health