Healthcare Provider Details

I. General information

NPI: 1831023480
Provider Name (Legal Business Name): ANNALISA NICOLE MELENDREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3680 E IMPERIAL HWY STE 504
LYNWOOD CA
90262-2659
US

IV. Provider business mailing address

1227 1/2 S SPRUCE ST
MONTEBELLO CA
90640-6463
US

V. Phone/Fax

Practice location:
  • Phone: 310-807-7545
  • Fax:
Mailing address:
  • Phone: 323-239-9389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number10184
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: