Healthcare Provider Details

I. General information

NPI: 1326647231
Provider Name (Legal Business Name): MELISSA PATINO ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2020
Last Update Date: 10/22/2020
Certification Date: 10/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5368
US

IV. Provider business mailing address

10929 SOUTH ST STE 208B
CERRITOS CA
90703-5368
US

V. Phone/Fax

Practice location:
  • Phone: 562-924-5526
  • Fax:
Mailing address:
  • Phone: 562-924-5526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number96758
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: