Individual
SUSETH ADRIANA FONSECA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
15720 VENTURA BLVD STE 420, ENCINO, CA 91436-4711
(818) 927-0478
Mailing address
437 E 98TH ST, INGLEWOOD, CA 90301-4207
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
14560
CA
Other
Enumeration date
04/03/2024
Last updated
04/03/2024
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