Basic Information
| Provider Information | |||||||||
| NPI: | 1376935445 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EALBA | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | LOUISE | ||||||||
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| Credential: | ASW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2275 S MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2275 S MAIN ST | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928825303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512793222 | ||||||||
| FaxNumber: | 9512795222 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/26/2015 | ||||||||
| LastUpdateDate: | 02/26/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 64318 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.