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General NPI Number Information
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NPI Number | 1629437090
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Entity Type | Organization
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Legal Business Name | GENESIS5 LLC
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Dates
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Enumeration Date | 02/15/2016
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Last Update Date | 02/15/2016
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Provider Practice Location Address
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Address Line | 7066 VILLAGE PARKWAY
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City | DUBLIN
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State | CA
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Zip | 94568
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Country | US
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Telephone | 925-324-2612
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Fax |
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Provider Business Mailing Address
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Address Line | 7066 VILLAGE PKWY
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City | DUBLIN
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State | CA
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Zip | 94568-2408
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Country | US
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Telephone | 925-318-5555
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | ALVIN PONCE
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Credential |
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Telephone | 925-324-2612
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 474684618
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License Number State | CA
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