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NPI Code Detail

MEDICARE: GENISIS CORAZON HERNANDEZ

MEDICARE: GENISIS CORAZON HERNANDEZ
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1225400000XRehabilitation Practitioner

General Provider Information

NPI Number : 1508405762
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENISIS CORAZON HERNANDEZ
Provider Business Mailing Address
First Line : 1510 FASHION ISLAND BLVD STE 310
Second Line :
City : SAN MATEO
State : CA
Zip : 94404-1587
Country : US
Telephone Number : 650-832-6900
Fax Number :
Provider Business Practice Location Address
First Line : 251 LLEWELLYN AVE
Second Line :
City : CAMPBELL
State : CA
Zip : 95008-1940
Country : US
Telephone Number : 408-379-3790
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2020
Last Update Date : 01/09/2026

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Directions to “ GENISIS CORAZON HERNANDEZ ” Practice Location

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