Healthcare Provider Details

I. General information

NPI: 1669348223
Provider Name (Legal Business Name): MELLIE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2025
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 N WESTERN AVE
HEMET CA
92543-3935
US

IV. Provider business mailing address

201 N WESTERN AVE
HEMET CA
92543-3935
US

V. Phone/Fax

Practice location:
  • Phone: 818-497-7963
  • Fax:
Mailing address:
  • Phone: 818-497-7963
  • Fax: 818-497-7963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State

VIII. Authorized Official

Name: MELISSA E CUELLAR
Title or Position: SOLE PROPRIETOR
Credential: CNMT
Phone: 818-497-7963