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General NPI Number Information
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NPI Number | 1104676451
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Entity Type | Individual
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Provider Name | ITALO GENESI
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Gender | Male
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Dates
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Enumeration Date | 03/26/2024
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Last Update Date | 03/26/2024
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Provider Practice Location Address
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Address Line | 7761 NW 107TH AVE OFC 210
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City | DORAL
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State | FL
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Zip | 33178-4059
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Country | US
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Telephone | 786-354-1183
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Fax |
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Provider Business Mailing Address
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Address Line | 7761 NW 107TH AVE OFC 210
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City | DORAL
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State | FL
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Zip | 33178-4059
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11032008
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License Number State | FL
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