Individual
GENESIS VILLALTA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3605 VISTA WAY STE 258, OCEANSIDE, CA 92056-4565
(760) 758-1480
Mailing address
3605 VISTA WAY STE 258, OCEANSIDE, CA 92056-4565
(760) 758-1480
(760) 435-9472
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
11/10/2023
Last updated
04/24/2025
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