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General NPI Number Information
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NPI Number | 1609305077
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Entity Type | Organization
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Legal Business Name | GENESIS OB ASSOCIATES, PC
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 06/08/2017
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Provider Practice Location Address
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Address Line | 300 HOSPITAL DR
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City | VALLEJO
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State | CA
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Zip | 94589-2574
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Country | US
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Telephone | 916-330-4259
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Fax | 916-357-7054
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Provider Business Mailing Address
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Address Line | 4944 WINDPLAY DR STE 200
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City | EL DORADO HILLS
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State | CA
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Zip | 95762-9310
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Country | US
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Telephone | 916-330-5259
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Fax | 916-357-7054
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | TODD JACKS
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Credential |
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Telephone | 916-330-4259
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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