Provider Demographics
NPI:1215546825
Name:HEALTHGENIX P.C.
Entity Type:Organization
Organization Name:HEALTHGENIX P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZMAYLOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-250-2876
Mailing Address - Street 1:836 TROTTER CT
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-6618
Mailing Address - Country:US
Mailing Address - Phone:818-624-1290
Mailing Address - Fax:
Practice Address - Street 1:130 LA CASA VIA STE 110
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3047
Practice Address - Country:US
Practice Address - Phone:925-885-8281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center