Provider Demographics
NPI:1154894863
Name:MESTAS, MELINA TANYA
Entity type:Individual
Prefix:
First Name:MELINA
Middle Name:TANYA
Last Name:MESTAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 EIDER DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9014
Mailing Address - Country:US
Mailing Address - Phone:209-894-5647
Mailing Address - Fax:
Practice Address - Street 1:400 EIDER DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:CA
Practice Address - Zip Code:95363-9014
Practice Address - Country:US
Practice Address - Phone:209-894-5647
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2019-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician