Healthcare Provider Details

I. General information

NPI: 1629972948
Provider Name (Legal Business Name): PABLO XAVIER GENZANA MEDINA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26 HH-1 URB. RIVERVIEW OFFICE 101
BAYAMON PR
00961
US

IV. Provider business mailing address

URB. VICTORIA HEIGHTS CALLE 7 BLQ. E #7
BAYAMON PR
00959
US

V. Phone/Fax

Practice location:
  • Phone: 787-688-1112
  • Fax:
Mailing address:
  • Phone: 787-688-1112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number1185
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: