Healthcare Provider Details

I. General information

NPI: 1467037788
Provider Name (Legal Business Name): GENESIS CARRERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CRESCENT WAY
ANAHEIM CA
92801-5401
US

IV. Provider business mailing address

11803 SKYLARK CIR APT 9204
WHITTIER CA
90606-1330
US

V. Phone/Fax

Practice location:
  • Phone: 714-999-3511
  • Fax:
Mailing address:
  • Phone: 323-767-4408
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: