Healthcare Provider Details

I. General information

NPI: 1962364075
Provider Name (Legal Business Name): GENESIS TMS OF TEMECULA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2025
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28765 SINGLE OAK DR STE 175
TEMECULA CA
92590-3658
US

IV. Provider business mailing address

137 S CENTER ST
TURLOCK CA
95380-4507
US

V. Phone/Fax

Practice location:
  • Phone: 209-222-1387
  • Fax: 877-252-3970
Mailing address:
  • Phone: 209-222-1387
  • Fax: 877-252-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: SANDRA COX
Title or Position: CO-OWNER
Credential: DO
Phone: 804-469-0044