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NPI Code Detail

MEDICARE: VANESSA BRISENO

MEDICARE: VANESSA BRISENO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistAMFT117768CA
2106H00000XMarriage & Family TherapistLMFT135282CA

General Provider Information

NPI Number : 1154634541
Entity Type Code : Individual
Provider Name (Legal Business Name) : VANESSA BRISENO
Provider Business Mailing Address
First Line : 4500 E PACIFIC COAST HWY STE 100
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-3233
Country : US
Telephone Number : 562-344-1140
Fax Number :
Provider Business Practice Location Address
First Line : 4500 E PACIFIC COAST HWY STE 100
Second Line :
City : LONG BEACH
State : CA
Zip : 90804-3233
Country : US
Telephone Number : 562-344-1140
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/14/2010
Last Update Date : 03/28/2023

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Directions to “ VANESSA BRISENO ” Practice Location

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