Healthcare Provider Details

I. General information

NPI: 1851818611
Provider Name (Legal Business Name): BRIANA JASMINE FONSECA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2017
Last Update Date: 06/16/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3404 W 168TH ST
TORRANCE CA
90504-1752
US

IV. Provider business mailing address

3404 W 168TH ST
TORRANCE CA
90504-1752
US

V. Phone/Fax

Practice location:
  • Phone: 310-533-4467
  • Fax: 310-972-6390
Mailing address:
  • Phone: 310-533-4467
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: