Provider Demographics
NPI:1093428088
Name:GARCIA, MELISSA TACEY
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:TACEY
Last Name:GARCIA
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 1:1480 E CALVADA BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:PAHRUMP
Mailing Address - State:NV
Mailing Address - Zip Code:89048-3962
Mailing Address - Country:US
Mailing Address - Phone:775-419-7595
Mailing Address - Fax:833-939-0185
Practice Address - Street 1:1480 E CALVADA BLVD STE 900
Practice Address - Street 2:
Practice Address - City:PAHRUMP
Practice Address - State:NV
Practice Address - Zip Code:89048-3962
Practice Address - Country:US
Practice Address - Phone:775-419-7595
Practice Address - Fax:833-939-0185
Is Sole Proprietor?:No
Enumeration Date:2023-01-04
Last Update Date:2025-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORBT-25-498288106S00000X
3747P1801X, 3747A0650X, 374U00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No374U00000XNursing Service Related ProvidersHome Health Aide
No376J00000XNursing Service Related ProvidersHomemaker