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General NPI Number Information
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NPI Number | 1811742307
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Entity Type | Organization
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Legal Business Name | GENESIS MEDICAL HEALTH A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 04/18/2024
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Last Update Date | 08/05/2024
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Provider Practice Location Address
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Address Line | 1155 E GRAND AVE STE 10
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City | ESCONDIDO
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State | CA
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Zip | 92025-3219
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Country | US
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Telephone | 760-644-4027
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Fax | 714-333-4262
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Provider Business Mailing Address
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Address Line | 1155 E GRAND AVE STE 10
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City | ESCONDIDO
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State | CA
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Zip | 92025-3219
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Country | US
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Telephone | 760-803-2005
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ROSIE CRUZ
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Credential |
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Telephone | 760-803-2005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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