Provider Demographics
NPI:1669340808
Name:BALBOA, MELAINE NICOLE
Entity type:Individual
Prefix:MS
First Name:MELAINE
Middle Name:NICOLE
Last Name:BALBOA
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 1:41516 MARINE DR
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92544-5806
Mailing Address - Country:US
Mailing Address - Phone:951-593-4677
Mailing Address - Fax:
Practice Address - Street 1:41516 MARINE DR
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92544-5806
Practice Address - Country:US
Practice Address - Phone:951-593-4677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-28
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician