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NPI Code Detail

MEDICARE: GENESIS ISLENO

MEDICARE: GENESIS ISLENO
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 Technician

General Provider Information

NPI Number : 1811695190
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENESIS ISLENO
Provider Business Mailing Address
First Line : 4708 LEHIGH CT
Second Line :
City : WOODBRIDGE
State : VA
Zip : 22193-4635
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 8405 RICHMOND HWY
Second Line :
City : ALEXANDRIA
State : VA
Zip : 22309-2425
Country : US
Telephone Number : 703-896-0760
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/16/2023
Last Update Date : 02/16/2023

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Directions to “ GENESIS ISLENO ” Practice Location

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