Healthcare Provider Details

I. General information

NPI: 1669124616
Provider Name (Legal Business Name): MELISSA DOMEYER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/21/2022
Last Update Date: 01/21/2022
Certification Date: 01/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25515 HOUSMAN PL
STEVENSON RANCH CA
91381-1427
US

IV. Provider business mailing address

2292 FARADAY AVE STE 100
CARLSBAD CA
92008-7238
US

V. Phone/Fax

Practice location:
  • Phone: 661-713-7184
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: