Healthcare Provider Details

I. General information

NPI: 1225941735
Provider Name (Legal Business Name): MELISSA YESSENIA GONZALEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

18785 HIGHWAY 94
DULZURA CA
91917-1403
US

IV. Provider business mailing address

18785 HIGHWAY 94
DULZURA CA
91917-1403
US

V. Phone/Fax

Practice location:
  • Phone: 310-649-0499
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101200000X
TaxonomyDrama Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: