Provider Demographics
NPI:1649204819
Name:GENINATTI, MARILYN REA (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:REA
Last Name:GENINATTI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 E PALO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-5160
Mailing Address - Country:US
Mailing Address - Phone:602-803-0302
Mailing Address - Fax:602-808-0905
Practice Address - Street 1:5502 E PALO VERDE DR
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-5160
Practice Address - Country:US
Practice Address - Phone:602-803-0302
Practice Address - Fax:602-808-0905
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12850207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ259128-02Medicaid
AZ106376Medicare ID - Type Unspecified
AZ259128-02Medicaid