Healthcare Provider Details

I. General information

NPI: 1013349091
Provider Name (Legal Business Name): GENESIS DOMINIQUE ARIZMENDI M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2013
Last Update Date: 08/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1374 W FRONTAGE RD
RIO RICO AZ
85648-6377
US

IV. Provider business mailing address

3319 E WATER ST # B
TUCSON AZ
85716-2562
US

V. Phone/Fax

Practice location:
  • Phone: 520-375-8289
  • Fax:
Mailing address:
  • Phone: 520-460-8399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberTSLP8451
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: