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General NPI Number Information
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NPI Number | 1801642301
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Entity Type | Individual
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Provider Name | MELISSA RUTH MARINO
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Gender | Female
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Dates
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Enumeration Date | 04/25/2024
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Last Update Date | 11/12/2025
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Provider Practice Location Address
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Address Line | 3491 CONCOURS
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City | ONTARIO
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State | CA
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Zip | 91764-5916
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Country | US
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Telephone | 909-284-4504
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Fax |
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Provider Business Mailing Address
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Address Line | 230 S WATERMAN AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1562
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 13940
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YS0200X
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Taxonomy Name | School Counselor
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License Number | 220117881
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License Number State | CA
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