MEDICARE: GRETCHEN DEBBIE GENATO FNP-C, PMHNP-BC

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	363LF0000X	Family Nurse Practitioner	AP61116932	WA
2	363LF0000X	Family Nurse Practitioner	173480	MT
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95003351	CA
4	363LF0000X	Family Nurse Practitioner	95003351	CA

General Provider Information

NPI Number	:	1245603174
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GRETCHEN DEBBIE GENATO FNP-C, PMHNP-BC

Provider Business Mailing Address
First Line	:	491 W 39TH ST APT 3
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-7040
Country	:	US
Telephone Number	:	424-505-0486
Fax Number	:

Provider Business Practice Location Address
First Line	:	3032 WILSHIRE BLVD STE A
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-2370
Country	:	US
Telephone Number	:	424-531-9941
Fax Number	:

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

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	08/13/2025

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