Healthcare Provider Details

I. General information

NPI: 1659264059
Provider Name (Legal Business Name): GABRIELA JEANNETTE MELENDEZ MARTINEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 08/17/2026
Certification Date: 08/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1303 SAN CARLOS AVE
SAN CARLOS CA
94070-2317
US

IV. Provider business mailing address

350 90TH ST FL 3
DALY CITY CA
94015-1879
US

V. Phone/Fax

Practice location:
  • Phone: 650-394-5155
  • Fax:
Mailing address:
  • Phone: 650-877-5700
  • Fax: 650-877-5701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164537
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: