Healthcare Provider Details

I. General information

NPI: 1558971317
Provider Name (Legal Business Name): MELANIE VORMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 406
TEMECULA CA
92591-4679
US

IV. Provider business mailing address

10174 OLD GROVE RD STE 100
SAN DIEGO CA
92131-1652
US

V. Phone/Fax

Practice location:
  • Phone: 951-694-5932
  • Fax:
Mailing address:
  • Phone: 858-444-8823
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: