Active NPI
Mellysa Wibowo
- Social Worker
- Orange, CA
National Provider Identifier
1508474016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- Practice address
- 4000 W Metropolitan Dr # 120
Orange, CA 92868-3504 - Phone
- (714) 972-3716
- NPI assigned
- Jul 21, 2020
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | CA | Primary |
Addresses
Primary practice location
4000 W Metropolitan Dr # 120
Orange, CA 92868-3504
Mailing address
4000 W Metropolitan Dr # 120
Orange, CA 92868-3504
Phone (714) 972-3716
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1595289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1601510400000",
"number": "1508474016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4000 W METROPOLITAN DR # 120",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683504",
"telephone_number": "714-972-3716"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4000 W METROPOLITAN DR # 120",
"city": "ORANGE",
"state": "CA",
"postal_code": "928683504",
"telephone_number": "714-972-3716"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIBOWO",
"first_name": "MELLYSA",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-07-21",
"last_updated": "2020-10-01",
"certification_date": "2020-10-01",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orange, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.