Healthcare Provider Details

I. General information

NPI: 1952934085
Provider Name (Legal Business Name): MELISSA GONZALEZ JOSEPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3281 E GUASTI RD STE 350
ONTARIO CA
91761-1236
US

IV. Provider business mailing address

24353 FIJI DR
MORENO VALLEY CA
92551-6938
US

V. Phone/Fax

Practice location:
  • Phone: 877-462-7735
  • Fax:
Mailing address:
  • Phone: 951-420-9789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW138669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: