=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093290926
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA RIOS PSYD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/26/2018
-----------------------------------------------------
Last Update Date | 07/07/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10605 BALBOA BLVD STE 100
-----------------------------------------------------
City | GRANADA HILLS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91344-6367
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-832-2400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10203 NASSAU AVE
-----------------------------------------------------
City | SUNLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91040-3349
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-741-0855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 35503
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------