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NPI Code Detail

MEDICARE: GENESIS GUILLEN

MEDICARE: GENESIS GUILLEN
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
11041C0700XClinical Social Worker100605CA
2101YM0800XMental Health Counselor100605CA

General Provider Information

NPI Number : 1205500444
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENESIS GUILLEN
Provider Business Mailing Address
First Line : PO BOX 1372
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93062-1372
Country : US
Telephone Number : 805-437-4982
Fax Number :
Provider Business Practice Location Address
First Line : 5297 MAUREEN LN
Second Line :
City : MOORPARK
State : CA
Zip : 93021-7125
Country : US
Telephone Number : 805-378-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2021
Last Update Date : 08/12/2025

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Directions to “ GENESIS GUILLEN ” Practice Location

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