=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962364075
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS TMS OF TEMECULA INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2025
-----------------------------------------------------
Last Update Date | 11/26/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 28765 SINGLE OAK DR STE 175
-----------------------------------------------------
City | TEMECULA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92590-3658
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-222-1387
-----------------------------------------------------
Fax | 877-252-3970
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 137 S CENTER ST
-----------------------------------------------------
City | TURLOCK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95380-4507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-222-1387
-----------------------------------------------------
Fax | 877-252-3970
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | SANDRA COX
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 804-469-0044
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080A0000X
-----------------------------------------------------
Taxonomy Name | Pediatric Adolescent Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------