Melissa Marie Brock

Primary specialty

Licensed Psychiatric TechnicianTaxonomy code 167G00000X

License

41003 Issued in CA

Practice address

679 S New Hampshire Ave
Los Angeles, CA 90005-1355

Phone

(626) 254-5000

NPI assigned

Nov 8, 2018

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Melissa Marie Ammerman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1541635200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1541635200000",
    "number": "1679041636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1931 ERIN AVE",
            "city": "UPLAND",
            "state": "CA",
            "postal_code": "917841545",
            "telephone_number": "909-771-8852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "679 S NEW HAMPSHIRE AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900051355",
            "telephone_number": "626-254-5000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROCK",
        "first_name": "MELISSA",
        "middle_name": "MARIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-11-08",
        "last_updated": "2018-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "167G00000X",
            "taxonomy_group": "",
            "desc": "Licensed Psychiatric Technician",
            "state": "CA",
            "license": "41003",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MELISSA",
            "last_name": "AMMERMAN",
            "middle_name": "MARIE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Broadway Medical Supply
• Broadway Radiology, Inc.
• Rosita Louise Broaster-Lotiff, MA
• Adela Brock
• Amina Brock
• Natasha Noelle Brock, ASW
• Selina Star Brock
• J Miranda Brocki, L.AC.
• Gail Brockman, MD
• Harvey Brockman

• Licensed Psychiatric Technician in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Licensed Psychiatric Technician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.