Healthcare Provider Details

I. General information

NPI: 1982984480
Provider Name (Legal Business Name): MELYSSA MACQUARRIE PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2011
Last Update Date: 12/24/2022
Certification Date: 12/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29900 GROUSE DR
TEHACHAPI CA
93561-5126
US

IV. Provider business mailing address

150 PAULARINO AVE SUITE C-100
COSTA MESA CA
92626-3301
US

V. Phone/Fax

Practice location:
  • Phone: 714-396-8037
  • Fax:
Mailing address:
  • Phone: 714-396-8037
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number18134
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: