Healthcare Provider Details

I. General information

NPI: 1104785476
Provider Name (Legal Business Name): MELINDA TUDOR
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2026
Last Update Date: 01/21/2026
Certification Date: 01/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27555 YNEZ RD STE 310
TEMECULA CA
92591-4678
US

IV. Provider business mailing address

22365 BARTON RD STE 104
GRAND TERRACE CA
92313-5037
US

V. Phone/Fax

Practice location:
  • Phone: 951-717-8919
  • Fax:
Mailing address:
  • Phone: 909-824-2899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number266
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: