Basic Information
| Provider Information | |||||||||
| NPI: | 1992110589 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MELENA | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 E 3RD ST | ||||||||
| Address2: | C | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900131629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136204712 | ||||||||
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| Practice Location | |||||||||
| Address1: | 470 E 3RD ST | ||||||||
| Address2: | C | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900131629 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2136204712 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/23/2014 | ||||||||
| LastUpdateDate: | 12/10/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/10/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 73863 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 1041C0700X | 93247 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.