Provider Demographics
NPI:1568057560
Name:HENDERSON, GENNA HAILEY
Entity Type:Individual
Prefix:
First Name:GENNA
Middle Name:HAILEY
Last Name:HENDERSON
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 1:19782 MACARTHUR BLVD STE 310
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2417
Mailing Address - Country:US
Mailing Address - Phone:949-929-9248
Mailing Address - Fax:929-209-2059
Practice Address - Street 1:19782 MACARTHUR BLVD STE 310
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92612-2417
Practice Address - Country:US
Practice Address - Phone:949-929-9248
Practice Address - Fax:929-209-2059
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator