Healthcare Provider Details

I. General information

NPI: 1346867322
Provider Name (Legal Business Name): MELISSA VASQUEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 10/09/2026
Certification Date: 10/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1563 MISSION ST
SAN FRANCISCO CA
94103-2543
US

IV. Provider business mailing address

2400 E KATELLA AVE STE 800
ANAHEIM CA
92806-5955
US

V. Phone/Fax

Practice location:
  • Phone: 415-762-3700
  • Fax:
Mailing address:
  • Phone: 714-858-3590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: