Provider Demographics
NPI:1356652838
Name:VELLA, MEISHA
Entity type:Individual
Prefix:
First Name:MEISHA
Middle Name:
Last Name:VELLA
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 1:384 JACKSON ST STE 1
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94544-1556
Mailing Address - Country:US
Mailing Address - Phone:510-931-5187
Mailing Address - Fax:510-346-5662
Practice Address - Street 1:384 JACKSON ST STE 1
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94544-1556
Practice Address - Country:US
Practice Address - Phone:510-931-5187
Practice Address - Fax:510-346-5662
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-29
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA699511041C0700X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator