Provider Demographics
NPI:1922330307
Name:MELGOZA, JESSICA MELISSA
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:MELISSA
Last Name:MELGOZA
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 1:1838 EASTMAN AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-6498
Mailing Address - Country:US
Mailing Address - Phone:805-289-0120
Mailing Address - Fax:805-289-0130
Practice Address - Street 1:1838 EASTMAN AVE STE 100
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-6498
Practice Address - Country:US
Practice Address - Phone:805-289-0120
Practice Address - Fax:805-289-0130
Is Sole Proprietor?:No
Enumeration Date:2010-02-09
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA56CCOtherASPIRANET