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NPI Code Detail

MEDICARE: GENESIS AUDREY STAFF

MEDICARE: GENESIS AUDREY STAFF
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1588510010
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENESIS AUDREY STAFF
Provider Business Mailing Address
First Line : 77 COUNTRY CLUB DR
Second Line :
City : CALIMESA
State : CA
Zip : 92320-2018
Country : US
Telephone Number : 909-768-2421
Fax Number :
Provider Business Practice Location Address
First Line : 11799 SEBASTIAN WAY STE 103
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-0708
Country : US
Telephone Number : 909-353-7547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2026
Last Update Date : 03/06/2026

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Directions to “ GENESIS AUDREY STAFF ” Practice Location

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