Healthcare Provider Details

I. General information

NPI: 1164359741
Provider Name (Legal Business Name): MELANIE BRIONES
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9444 BALBOA AVE
SAN DIEGO CA
92123-4447
US

IV. Provider business mailing address

9444 BALBOA AVE
SAN DIEGO CA
92123-4447
US

V. Phone/Fax

Practice location:
  • Phone: 619-925-9620
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: