Healthcare Provider Details

I. General information

NPI: 1568599694
Provider Name (Legal Business Name): GENOVEVA TENORIO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1607 E US HIGHWAY 136
ALBANY MO
64402-8223
US

IV. Provider business mailing address

PO BOX 176
ALBANY MO
64402-0176
US

V. Phone/Fax

Practice location:
  • Phone: 660-726-3974
  • Fax: 660-726-3851
Mailing address:
  • Phone: 660-726-3974
  • Fax: 660-726-3851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35774
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: