Individual
GENEVIEVE MAYA FRAGOSO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
180 VIA VERDE STE 200, SAN DIMAS, CA 91773-3993
(909) 599-1227
Mailing address
180 VIA VERDE STE 200, SAN DIMAS, CA 91773-3993
(909) 599-1227
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
15247
CA
Other
Enumeration date
07/20/2022
Last updated
02/01/2024
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