Individual
MELISSA MARIE BROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
679 S NEW HAMPSHIRE AVE, LOS ANGELES, CA 90005-1355
(626) 254-5000
Mailing address
1931 ERIN AVE, UPLAND, CA 91784-1545
(909) 771-8852
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
41003
CA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
11/08/2018
Last updated
11/08/2018
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