Healthcare Provider Details

I. General information

NPI: 1538932751
Provider Name (Legal Business Name): GENESIS MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2023
Last Update Date: 12/26/2023
Certification Date: 12/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 SUPERIOR AVE STE 200A
NEWPORT BEACH CA
92663-3664
US

IV. Provider business mailing address

3301 MICHELSON DR APT 3318
IRVINE CA
92612-4321
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-8070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS1201X
TaxonomySleep Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MENEENA BRIGHT
Title or Position: PRESIDENT
Credential: MD
Phone: 202-372-5171