Provider Demographics
NPI:1184868028
Name:DOTSON-GARY, GENIENE
Entity Type:Individual
Prefix:
First Name:GENIENE
Middle Name:
Last Name:DOTSON-GARY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8240 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90606-3120
Mailing Address - Country:US
Mailing Address - Phone:562-908-3100
Mailing Address - Fax:562-908-0575
Practice Address - Street 1:9150 IMPERIAL HWY
Practice Address - Street 2:ROOM P-31
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2835
Practice Address - Country:US
Practice Address - Phone:562-940-3694
Practice Address - Fax:562-658-7425
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-22
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator