Healthcare Provider Details

I. General information

NPI: 1134857295
Provider Name (Legal Business Name): ALONDRA BRIZELL GOMEZ DUARTE APCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2022
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 4TH AVE STE 3
SAN DIEGO CA
92103-6223
US

IV. Provider business mailing address

3056 GLANCY DR
SAN DIEGO CA
92173-2881
US

V. Phone/Fax

Practice location:
  • Phone: 619-616-0733
  • Fax:
Mailing address:
  • Phone: 619-906-1079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number21542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: