MEDICARE: MISS GESSELLE C MAYORGA

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
1	106H00000X	Marriage & Family Therapist	93707	CA

General Provider Information

NPI Number	:	1407299548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS GESSELLE C MAYORGA

Provider Business Mailing Address
First Line	:	1023 N HOLLYWOOD WAY
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-2539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 W ALAMEDA AVE STE 300-1207
Second Line	:
City	:	BURBANK
State	:	CA
Zip	:	91505-4195
Country	:	US
Telephone Number	:	818-276-6970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/08/2013
Last Update Date	:	01/22/2026

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