Provider Demographics
NPI:1760365670
Name:BAEZA, MELANIE
Entity type:Individual
Prefix:
First Name:MELANIE
Middle Name:
Last Name:BAEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4370 PALM AVE
Mailing Address - Street 2:SUITE D PO BOX 1018
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-1760
Mailing Address - Country:US
Mailing Address - Phone:619-363-1375
Mailing Address - Fax:
Practice Address - Street 1:4370 PALM AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-1760
Practice Address - Country:US
Practice Address - Phone:619-363-1375
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-28
Last Update Date:2025-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW1314981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical