Healthcare Provider Details

I. General information

NPI: 1780131029
Provider Name (Legal Business Name): SCOTT MELGREN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2016
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32605 TEMECULA PKWY
TEMECULA CA
92592-6837
US

IV. Provider business mailing address

16 STONE TURRET CT
LADERA RANCH CA
92694-0423
US

V. Phone/Fax

Practice location:
  • Phone: 877-840-6956
  • Fax:
Mailing address:
  • Phone: 949-690-9876
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number104756
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121745
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: