Provider Demographics
NPI:1568118685
Name:GENESIS INFINITY MEDICAL GROUP
Entity Type:Organization
Organization Name:GENESIS INFINITY MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNFREI
Authorized Official - Middle Name:
Authorized Official - Last Name:DELARIMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-227-9151
Mailing Address - Street 1:2445-2447 SANTA CLARA AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501
Mailing Address - Country:US
Mailing Address - Phone:510-426-5640
Mailing Address - Fax:
Practice Address - Street 1:2445-2447 SANTA CLARA AVE STE 305
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501
Practice Address - Country:US
Practice Address - Phone:510-426-5640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-28
Last Update Date:2022-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty