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General NPI Number Information
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NPI Number | 1740623867
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Entity Type | Individual
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Provider Name | GENISE MARIE SWAIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/08/2013
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Last Update Date | 04/08/2013
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Provider Practice Location Address
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Address Line | 731 EL CERRITO PLZ
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City | EL CERRITO
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State | CA
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Zip | 94530-4022
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Country | US
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Telephone | 510-559-7975
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Fax |
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Provider Business Mailing Address
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Address Line | 30 DEUCE CT
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City | FAIRFAX
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State | CA
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Zip | 94930-1308
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Country | US
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Telephone | 415-456-2746
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 14833
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License Number State | CA
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