Individual
GENESIS BERENICE GOMEZ-TELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4211 AVALON BLVD, LOS ANGELES, CA 90011-5622
(323) 233-0425
Mailing address
4211 AVALON BLVD, LOS ANGELES, CA 90011-5622
(323) 233-0425
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
87605
CA
104100000X
Social Worker
Primary
112321
CA
104100000X
Social Worker
87605
CA
Other
Enumeration date
03/05/2019
Last updated
12/01/2022
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