Healthcare Provider Details

I. General information

NPI: 1972494011
Provider Name (Legal Business Name): MORENA MEJIA MELENDEZ ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 06/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22850 CALLE DE LOS LAGOS
MORENO VALLEY CA
92553
US

IV. Provider business mailing address

920 N EMILY ST
ANAHEIM CA
92805-1909
US

V. Phone/Fax

Practice location:
  • Phone: 951-486-6700
  • Fax:
Mailing address:
  • Phone: 714-650-6479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number115598
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: