MEDICARE: MELISSA PRINCE

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
1	103TS0200X	School Psychologist

General Provider Information

NPI Number	:	1972452944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA PRINCE

Provider Business Mailing Address
First Line	:	3777 MOORE ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-3534
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2600 RIPLEY AVE
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90278-4555
Country	:	US
Telephone Number	:	310-798-8636
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/23/2026
Last Update Date	:	01/23/2026

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Directions to “ MELISSA PRINCE ” Practice Location

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