Healthcare Provider Details

I. General information

NPI: 1548033822
Provider Name (Legal Business Name): MELISA VICTORIA GARCIA SUDRC #16674
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 PEACH DR
SALINAS CA
93901-3710
US

IV. Provider business mailing address

1208 PADRE DR
SALINAS CA
93901-2211
US

V. Phone/Fax

Practice location:
  • Phone: 831-753-6001
  • Fax:
Mailing address:
  • Phone: 831-682-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: