Healthcare Provider Details

I. General information

NPI: 1811873862
Provider Name (Legal Business Name): MELISSA BADER-HUESGEN RADT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2025
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23103 COFFEE BERRY CIR
CORONA CA
92883-8138
US

IV. Provider business mailing address

1901 E 4TH ST STE 350
SANTA ANA CA
92705-3908
US

V. Phone/Fax

Practice location:
  • Phone: 949-683-1733
  • Fax:
Mailing address:
  • Phone: 714-788-8686
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number810A74EBFB
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: