MELISSA BOUCHARD (NPI# 1083173629) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083173629 |
| Entity Type | Individual |
| Full Name | MELISSA BOUCHARD |
| Practice Address |
4104 Delta St San Diego CA 92113-4113 |
| Practice Telephone | 6192640141 |
| Mailing Telephone | 6192640141 |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-03-13 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 175T00000X | Peer Specialist | CA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164933396 | Melissa Beth Bouchard | Contractor | 32411 Briarcrest Knls, Farmington Hills, MI 48334-1515 | 2017-10-16 |
| 1275016792 | Melissa Joann Bouchard | Case Manager/Care Coordinator | 401 W. Main St., Barnsdall, OK 74002-0000 | 2018-09-11 |
| Street Address |
4104 DELTA ST |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92113-4113 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1013031541 | Traditin One, Inc | Substance Abuse Rehabilitation Facility | 4104 Delta St, San Diego, CA 92113-4113 | 2007-03-19 |
| 1740829233 | James Richard Gamble Sr. | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-12-31 |
| 1376184408 | Patrick Wallace | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-09-30 |
| 1538719174 | Delores Von Mirbach | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-09-16 |
| 1255985917 | Ralph Anthony Ramirez | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-07-30 |
| 1134683337 | Cassandra Elizabeth Arnold | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-01-22 |
| 1679037873 | Albert Lee Cherry Jr. | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-01-22 |
| 1063986529 | Peter Ross Ratkovich | Counselor | 4104 Delta St, San Diego, CA 92113-4113 | 2019-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609305986 | Cynthia Alba | Nutritionist | 1809 National Ave., San Diego, CA 92113 | 2017-06-08 |
| 1184153983 | Jessy Milligan | Counselor | 4125 Alpha Street, San Diego, CA 92113 | 2017-06-06 |
| 1730557406 | Deborah Mary Malloy | Counselor | Jary Barreto, 2865 Logan Avenue, San Diego, CA 92113 | 2015-09-10 |
| 1104220912 | Imhotep Mustaqeem | Counselor | 3336 Steel Street, San Diego, CA 92113 | 2014-10-22 |
| 1831507300 | Olga Vasileva | Student in an Organized Health Care Education/Training Program | 2865 Logan Avenue, San Diego, CA 92113 | 2014-07-29 |
| 1477961951 | Angelica Quezada | Counselor | 32510 Newton Avenue B103, San Diego, CA 92113 | 2014-07-28 |
| 1477986750 | Anita Pena | Licensed Vocational Nurse | 604 Olivewood Ter, San Diego, CA 92113 | 2013-08-09 |
| 1134459399 | Susana Cabada | Technician, Other | 4031 Marine View Ave., San Diego, CA 92113 | 2010-01-11 |
| 1669595609 | Maria Emilia Siller | Registered Nurse | 3177a Oceanview Blvd, San Diego, AL 92113 | 2007-04-06 |
| 1710009691 | Maria Engracia Siordia | Licensed Vocational Nurse | 3177a Ocean View Blvd, San Diego, CA 92113 | 2007-04-04 |
| Find all providers in zip 92113 | ||||
| Taxonomy Code | 175T00000X |
| Grouping | Other Service Providers |
| Classification | Peer Specialist |
| Individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. |
| Notes: Source: National Uniform Claim Committee [7/1/2014: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043826753 | Dayjahnay Shantay Davenport | Peer Specialist | 3347 Lincoln Ave, San Diego, CA 92104-2111 | 2020-09-17 |
| 1427683101 | Gerardo Castro | Peer Specialist | 5555 Reservoir Dr # 204-a, San Diego, CA 92120-5134 | 2020-03-03 |
| 1487298840 | Garrett Ives | Peer Specialist | 2909 Keats St Apt 7, San Diego, CA 92106-2345 | 2019-10-29 |
| 1144882622 | Melissa Ratsamy | Peer Specialist | 286 Euclid Ave Project Enable, #102, San Diego, CA 92114 | 2019-07-03 |
| 1699258459 | Talya Donahue | Peer Specialist | 1045 Ninth Ave, San Diego, CA 92101 | 2018-09-07 |
| 1811434467 | Deborah Sue Lynn | Peer Specialist | 140 W. Arbor Dr., Ucsd Gifford Outpatient Clinic, San Diego, CA 92103-2421 | 2017-01-20 |
| 1023463163 | Miguel Pablo Surposa | Peer Specialist | 5711 Bolivar St, San Diego, CA 92139-1617 | 2016-04-26 |
| 1376140590 | Leon Samuel Mancilla | Peer Specialist | 5555 Reservoir Dr, San Diego, CA 92120-5134 | 2020-10-01 |
| 1982210092 | Nicole Lynn Iwan | Peer Specialist | 3491 Kurtz St Ste 150, San Diego, CA 92110-4430 | 2020-09-23 |
| 1962014001 | Paulina Alvarado | Peer Specialist | 6160 Mission Gorge Rd, San Diego, CA 92120-3410 | 2020-08-19 |
| Find all providers in SAN DIEGO | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.