Provider Demographics
NPI:1588421119
Name:MARMOL VARGAS, MELODY BRIANA
Entity type:Individual
Prefix:MS
First Name:MELODY
Middle Name:BRIANA
Last Name:MARMOL VARGAS
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:PO BOX 2612
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92814-0612
Mailing Address - Country:US
Mailing Address - Phone:714-335-9672
Mailing Address - Fax:
Practice Address - Street 1:2275 W BROADWAY APT M202
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-1333
Practice Address - Country:US
Practice Address - Phone:714-335-9672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician