Healthcare Provider Details

I. General information

NPI: 1104771260
Provider Name (Legal Business Name): MELANIEE ILIANA VILCHES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2026
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15621 VANOWEN ST
VAN NUYS CA
91406-7210
US

IV. Provider business mailing address

14421 CHATSWORTH DR
SAN FERNANDO CA
91340-4308
US

V. Phone/Fax

Practice location:
  • Phone: 818-386-8303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: