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General NPI Number Information
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NPI Number | 1295175180
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Entity Type | Organization
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Legal Business Name | GENESIS WOMENS MEDICAL GROUP, INC
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Dates
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Enumeration Date | 06/25/2013
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Last Update Date | 09/16/2013
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Provider Practice Location Address
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Address Line | 502 EUCLID AVE STE 200
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2984
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Country | US
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Telephone | 619-475-1261
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Fax | 619-475-1267
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Provider Business Mailing Address
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Address Line | 502 EUCLID AVE STE 200
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City | NATIONAL CITY
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State | CA
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Zip | 91950-2984
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Country | US
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Telephone | 619-475-1261
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Fax | 619-475-1267
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. ABIADE C SHORT
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Credential | MD
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Telephone | 619-475-1261
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | A114893
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License Number State | CA
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