Melissa Kiyo Broberg
Individual provider Active NPI Behavior Technician · Stanton, CA
NPI 1982164505 · NPPES record last updated Mar 20, 2019
Key facts
- NPI
- 1982164505
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Technician 106S00000X
- Practice address
- 12235 Beach Blvd
Stanton, CA 90680-3939 - Phone
- (714) 202-0118
- NPI assigned
- Mar 20, 2019
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Yes |
Addresses
Primary practice location
12235 Beach Blvd
Stanton, CA 90680-3939
Mailing address
16825 Pembrook LN
Huntington Beach, CA 92649-6022
Phone (714) 606-3885
Other providers in Stanton, CA
- Jeffery Boots
- Morgan Leigh Boyer
- Rachel Laura Bradley
- Sam Brandel
- Glen Brinagh
- Tamara Brown
- Melvin Broxton
- Gracie Bui
- Hai Bui
- Huy Bui
All providers in Stanton, CA · Behavior Technician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 20, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.