Provider Demographics
NPI:1245603174
Name:GENATO, GRETCHEN DEBBIE (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:DEBBIE
Last Name:GENATO
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:491 W 39TH ST APT 3
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-7040
Mailing Address - Country:US
Mailing Address - Phone:424-505-0486
Mailing Address - Fax:
Practice Address - Street 1:3032 WILSHIRE BLVD STE A
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2370
Practice Address - Country:US
Practice Address - Phone:424-531-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2025-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP61116932363LF0000X
MT173480363LF0000X
CA95003351363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty