Basic Information
| Provider Information | |||||||||
| NPI: | 1407299456 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | PIERCE | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21600 OXNARD ST STE 1030 | ||||||||
| Address2: | |||||||||
| City: | WOODLAND HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913675085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772061009 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 55475 SANTA FE TRL | ||||||||
| Address2: | |||||||||
| City: | YUCCA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922843117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603653022 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 09/01/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 106S00000X | Y |
No ID Information.