Healthcare Provider Details

I. General information

NPI: 1326052457
Provider Name (Legal Business Name): KELLY KATHLEEN GENOVESE NP,RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 MESA DR STE 5
OCEANSIDE CA
92054-3701
US

IV. Provider business mailing address

150 VALPREDA RD
SAN MARCOS CA
92069-2973
US

V. Phone/Fax

Practice location:
  • Phone: 760-736-6767
  • Fax:
Mailing address:
  • Phone: 760-736-6767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number6414
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: