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General NPI Number Information
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NPI Number | 1750237103
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Entity Type | Organization
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Legal Business Name | QUANTUM AI BLUE ZONE WELLNESS AND HOLISTIC REGENERATIVE SYSTEMS, NURSING AND NEUROECONOMIC LONGEVITY
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Dates
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Enumeration Date | 03/09/2026
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Last Update Date | 03/09/2026
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Provider Practice Location Address
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Address Line | 491 W 39TH ST APT 3
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City | SAN PEDRO
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State | CA
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Zip | 90731-7040
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Country | US
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Telephone | 424-505-0486
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Fax | 424-999-0390
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Provider Business Mailing Address
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Address Line | 491 W 39TH ST APT 3
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City | SAN PEDRO
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State | CA
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Zip | 90731-7040
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Country | US
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Telephone | 424-505-0486
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Fax | 424-999-0390
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Authorized Official
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Title or Position | PRESIDENT
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Name | GRETCHEN GENATO
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Credential | PMHNP-BC
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Telephone | 424-505-0486
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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