Healthcare Provider Details

I. General information

NPI: 1306090857
Provider Name (Legal Business Name): BEVERLY GENIS R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2008
Last Update Date: 09/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21422 PENSACOLA CIR
HUNTINGTON BEACH CA
92646-7549
US

IV. Provider business mailing address

21422 PENSACOLA CIR
HUNTINGTON BEACH CA
92646-7549
US

V. Phone/Fax

Practice location:
  • Phone: 714-593-8387
  • Fax: 714-593-8387
Mailing address:
  • Phone: 714-593-8387
  • Fax: 714-593-8387

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number293925
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: