Healthcare Provider Details

I. General information

NPI: 1154151900
Provider Name (Legal Business Name): MELISSA MIJARES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

IV. Provider business mailing address

1160 S GRAND AVE
GLENDORA CA
91740-5000
US

V. Phone/Fax

Practice location:
  • Phone: 626-335-5980
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW131453
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: