Healthcare Provider Details

I. General information

NPI: 1225196793
Provider Name (Legal Business Name): MS. MELISSA MOPPINS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 09/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

IV. Provider business mailing address

2275 ARLINGTON DR
SAN LEANDRO CA
94578-1132
US

V. Phone/Fax

Practice location:
  • Phone: 510-777-5300
  • Fax: 510-317-1144
Mailing address:
  • Phone: 510-772-7984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number24974
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: