Healthcare Provider Details

I. General information

NPI: 1083058283
Provider Name (Legal Business Name): MELISSA DE LA CRUZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MELISSA QUINTANA LCSW, PPSC

II. Dates (important events)

Enumeration Date: 04/18/2013
Last Update Date: 01/09/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

IV. Provider business mailing address

9300 IMPERIAL HWY
DOWNEY CA
90242-2813
US

V. Phone/Fax

Practice location:
  • Phone: 562-922-7488
  • Fax:
Mailing address:
  • Phone: 562-922-7488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: