Individual
MELISSA LICEA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4382 WRIGHT BROTHERS ST, JURUPA VALLEY, CA 92509-7831
(951) 703-5355
Mailing address
4382 WRIGHT BROTHERS ST, JURUPA VALLEY, CA 92509-7831
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
4524136
CA
Other
Enumeration date
07/21/2026
Last updated
07/21/2026
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