Healthcare Provider Details

I. General information

NPI: 1720624901
Provider Name (Legal Business Name): MELISSA GALLARDO ZUNIGA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 10727
GLENDALE AZ
85318-0727
US

IV. Provider business mailing address

4314 S 104TH LN
TOLLESON AZ
85353-4178
US

V. Phone/Fax

Practice location:
  • Phone: 623-261-7124
  • Fax:
Mailing address:
  • Phone: 623-696-5752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23551
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: