Healthcare Provider Details

I. General information

NPI: 1265875108
Provider Name (Legal Business Name): GENESIS TCM CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2013
Last Update Date: 11/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 34TH ST SUITE 200
ORLANDO FL
32805-6601
US

IV. Provider business mailing address

3700 34TH ST SUITE 200
ORLANDO FL
32805-6601
US

V. Phone/Fax

Practice location:
  • Phone: 407-350-7911
  • Fax:
Mailing address:
  • Phone: 407-350-7911
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. HUMBERTO J. SANTIAGO
Title or Position: PRESIDENT
Credential:
Phone: 407-350-7911