Healthcare Provider Details

I. General information

NPI: 1982532636
Provider Name (Legal Business Name): VANESSA MELARA BA, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2026
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39210 STATE ST STE 220
FREMONT CA
94538-1456
US

IV. Provider business mailing address

1325 W LOWELL AVE
TRACY CA
95376-2913
US

V. Phone/Fax

Practice location:
  • Phone: 908-249-7902
  • Fax:
Mailing address:
  • Phone: 908-249-7902
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number46-1305562
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: