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General NPI Number Information
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NPI Number | 1467640409
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Entity Type | Organization
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Legal Business Name | GENESIS FAMILY CARE MEDICAL GROUP, INC.
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Dates
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Enumeration Date | 10/03/2007
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Last Update Date | 05/29/2015
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Provider Practice Location Address
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Address Line | 1101 N SEPULVEDA BLVD STE 102
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5962
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Country | US
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Telephone | 310-545-6627
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Fax | 310-545-0352
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Provider Business Mailing Address
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Address Line | 1101 N SEPULVEDA BLVD STE 102
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-5962
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Country | US
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Telephone | 310-545-6627
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Fax | 310-545-0352
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RONALD RUBY J.
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Credential |
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Telephone | 310-545-6627
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RE0101X
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Taxonomy Name | Endocrinology, Diabetes & Metabolism Physician
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License Number | G34101
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License Number State | CA
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