Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003092826 |
---|---|
Provider Name | Mr. Alicia Melgoza |
First Address | Woodland, CA 95695-2585 |
Second Address | Woodland, CA 95695-2585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/01/2008 |
Last Update Date | 10/01/2008 |