Healthcare Provider Details

I. General information

NPI: 1881849537
Provider Name (Legal Business Name): GENESIS SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2008
Last Update Date: 11/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 RAINBOW TROUT CT
ROSEVILLE CA
95747-4628
US

IV. Provider business mailing address

324 RAINBOW TROUT CT
ROSEVILLE CA
95747-4628
US

V. Phone/Fax

Practice location:
  • Phone: 916-801-1673
  • Fax: 916-781-2425
Mailing address:
  • Phone: 916-801-1673
  • Fax: 916-781-2425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ERIK TRUXAL
Title or Position: PRESIDENT
Credential:
Phone: 916-801-1673