Healthcare Provider Details

I. General information

NPI: 1013165018
Provider Name (Legal Business Name): MELISSA HUITRON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MELISSA SANTOS

II. Dates (important events)

Enumeration Date: 09/03/2008
Last Update Date: 12/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 S KINNELOA AVE SUITE 200
PASADENA CA
91107-3853
US

IV. Provider business mailing address

36 S KINNELOA AVE SUITE 200
PASADENA CA
91107-3853
US

V. Phone/Fax

Practice location:
  • Phone: 626-372-1094
  • Fax:
Mailing address:
  • Phone: 626-372-1094
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: