Provider Demographics
NPI:1720624901
Name:ZUNIGA, MELISSA GALLARDO
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GALLARDO
Last Name:ZUNIGA
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 1:4314 S 104TH LN
Mailing Address - Street 2:
Mailing Address - City:TOLLESON
Mailing Address - State:AZ
Mailing Address - Zip Code:85353-4178
Mailing Address - Country:US
Mailing Address - Phone:623-696-5752
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 10727
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85318-0727
Practice Address - Country:US
Practice Address - Phone:623-261-7124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-21
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ23551101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional