Provider Demographics
NPI:1548033822
Name:GARCIA, MELISA VICTORIA (SUDRC #16674)
Entity type:Individual
Prefix:
First Name:MELISA
Middle Name:VICTORIA
Last Name:GARCIA
Suffix:
Gender:F
Credentials:SUDRC #16674
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 PADRE DR
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2211
Mailing Address - Country:US
Mailing Address - Phone:831-682-2602
Mailing Address - Fax:
Practice Address - Street 1:11 PEACH DR
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3710
Practice Address - Country:US
Practice Address - Phone:831-753-6001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)