Provider Demographics
NPI:1932477486
Name:MATA, MELISSA ANNMARIE
Entity Type:Individual
Prefix:MS
First Name:MELISSA
Middle Name:ANNMARIE
Last Name:MATA
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 1:1083 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2323
Mailing Address - Country:US
Mailing Address - Phone:831-424-4828
Mailing Address - Fax:831-424-5838
Practice Address - Street 1:1083 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2323
Practice Address - Country:US
Practice Address - Phone:831-424-4828
Practice Address - Fax:831-424-5838
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMMATA75Medicaid