Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VX0201X | Gynecologic Oncologist | G061853 | CA |
NPI | 1043250566 |
---|---|
Provider Name | Mark C Genesen |
First Address | Rancho Mirage, CA 92270-3221 |
Second Address | Rancho Mirage, CA 92270-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/06/2006 |
Last Update Date | 25/10/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E98073 | (02) | CA |