Provider Demographics
NPI:1396368015
Name:GENOV, MAUREEN (PA-C)
Entity Type:Individual
Prefix:
First Name:MAUREEN
Middle Name:
Last Name:GENOV
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 BABCOCK RD
Mailing Address - Street 2:STE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4870
Mailing Address - Country:US
Mailing Address - Phone:210-616-0882
Mailing Address - Fax:210-616-5396
Practice Address - Street 1:540 MADISON OAK DR STE 450
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3932
Practice Address - Country:US
Practice Address - Phone:210-499-4824
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA13400363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant