MEDICARE: MELISSA SURAIMA HERNANDEZ

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	146960	CA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	225400000X	Rehabilitation Practitioner

General Provider Information

NPI Number	:	1881180370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA SURAIMA HERNANDEZ

Provider Business Mailing Address
First Line	:	1734 N RIVERSIDE AVE STE 1
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376-8058
Country	:	US
Telephone Number	:	818-908-4990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1734 N RIVERSIDE AVE STE 1
Second Line	:
City	:	RIALTO
State	:	CA
Zip	:	92376-8058
Country	:	US
Telephone Number	:	818-908-4990
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/08/2018
Last Update Date	:	04/13/2026

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