Healthcare Provider Details

I. General information

NPI: 1093140535
Provider Name (Legal Business Name): MELISSA HEATHER MATUGAS MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2013
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2503 HILLCREST DR
LOS ANGELES CA
90016-2903
US

IV. Provider business mailing address

PO BOX 78386
LOS ANGELES CA
90016-0386
US

V. Phone/Fax

Practice location:
  • Phone: 425-345-6256
  • Fax:
Mailing address:
  • Phone: 425-345-6256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number83727
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW-4987
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: