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NPI Code Detail

MEDICARE: MELYSSA ARIADNA GONZALEZ

MEDICARE: MELYSSA ARIADNA GONZALEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1184577678
Entity Type Code : Individual
Provider Name (Legal Business Name) : MELYSSA ARIADNA GONZALEZ
Provider Business Mailing Address
First Line : 4401 CRENSHAW BLVD STE 215
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043-1200
Country : US
Telephone Number : 323-291-7100
Fax Number :
Provider Business Practice Location Address
First Line : 4401 CRENSHAW BLVD STE 215
Second Line :
City : LOS ANGELES
State : CA
Zip : 90043-1200
Country : US
Telephone Number : 323-291-7100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2026
Last Update Date : 02/16/2026

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Directions to “ MELYSSA ARIADNA GONZALEZ ” Practice Location

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