Healthcare Provider Details

I. General information

NPI: 1528978384
Provider Name (Legal Business Name): MELISSA LUGO BRISENO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2026
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 BROOKSIDE RD STE D
STOCKTON CA
95219-1775
US

IV. Provider business mailing address

2322 OAK HILL ST
STOCKTON CA
95206-4723
US

V. Phone/Fax

Practice location:
  • Phone: 833-227-3454
  • 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 StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: