Provider Demographics
NPI:1407303951
Name:GENESIS BIOMED, INC.
Entity Type:Organization
Organization Name:GENESIS BIOMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON ESPINOZA
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:ESPINOZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-331-6047
Mailing Address - Street 1:3493 IRVINE BLVD
Mailing Address - Street 2:#241
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92602
Mailing Address - Country:US
Mailing Address - Phone:949-331-6047
Mailing Address - Fax:
Practice Address - Street 1:3493 IRVINE BLVD
Practice Address - Street 2:#241
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92602
Practice Address - Country:US
Practice Address - Phone:949-331-6047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies