Provider Demographics
NPI:1871025569
Name:MELENDEZ, ANGELA MARIE (CAODC-6781)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:MARIE
Last Name:MELENDEZ
Suffix:
Gender:F
Credentials:CAODC-6781
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 G ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BRAWLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92227-2357
Mailing Address - Country:US
Mailing Address - Phone:805-268-8820
Mailing Address - Fax:
Practice Address - Street 1:535 CESAR CHAVEZ BLVD
Practice Address - Street 2:
Practice Address - City:CALEXICO
Practice Address - State:CA
Practice Address - Zip Code:92231-2103
Practice Address - Country:US
Practice Address - Phone:760-357-6566
Practice Address - Fax:760-357-0849
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2019-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAODC-6781101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA953069805Medicaid