Healthcare Provider Details

I. General information

NPI: 1114794989
Provider Name (Legal Business Name): MELISA GUADALUPE GARCIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2023
Last Update Date: 03/30/2026
Certification Date: 03/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36947 COOK ST STE 103
PALM DESERT CA
92211-6078
US

IV. Provider business mailing address

83801 DR CARREON BLVD APT 1303
INDIO CA
92201-7171
US

V. Phone/Fax

Practice location:
  • Phone: 760-469-9650
  • Fax:
Mailing address:
  • Phone: 760-708-5566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: