Healthcare Provider Details

I. General information

NPI: 1639710643
Provider Name (Legal Business Name): GENIEMD MEDICAL GROUP, MO, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2019
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BROADWAY STE 300
OAKLAND CA
94607-4167
US

IV. Provider business mailing address

9000 CROW CANYON RD
DANVILLE CA
94506-1189
US

V. Phone/Fax

Practice location:
  • Phone: 925-460-9191
  • Fax:
Mailing address:
  • Phone: 925-460-9191
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. DAVID MANSOUR FILSOOF
Title or Position: PRESIDENT
Credential: MD
Phone: 925-460-9191