Healthcare Provider Details

I. General information

NPI: 1083108401
Provider Name (Legal Business Name): GENY AUGUSTINE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2018
Last Update Date: 03/17/2026
Certification Date: 03/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 WARREN ST STE 300
REDWOOD CITY CA
94063-1536
US

IV. Provider business mailing address

7701 W ASPERA BLVD
GLENDALE AZ
85308-7947
US

V. Phone/Fax

Practice location:
  • Phone: 240-693-3281
  • Fax:
Mailing address:
  • Phone: 623-465-6060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number63631
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT216298
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: