Genesis Medspa, INC

NPI #1992048250 in Canoga Park, California

Provider Information

NPI Number: 1992048250
Entity Type: Organization
Organization Name: Genesis Medspa, INC
Primary Specialty: Internal Medicine
Enumeration Date: Apr 4, 2013
Last Updated: Apr 4, 2013

Practice Location

Address: 22323 SHERMAN WAY
Address 2: SUITE # 19-20
City: Canoga Park
State: California
ZIP Code: 91303-1002
Phone: (818) 884-8110

Authorized Official

Name: MS. MARGARITA LOZADA FERNANDEZ, NURSE PRACTITIONER
Title: SECRETARY
Phone: (858) 254-3762

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Internal Medicine	207R00000X	Primary

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