Provider Demographics
NPI:1336221860
Name:GENOVA, ANNETTE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:MARIE
Last Name:GENOVA
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:PO BOX 4245
Mailing Address - Street 2:
Mailing Address - City:RENONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1759
Mailing Address - Country:US
Mailing Address - Phone:310-528-2996
Mailing Address - Fax:310-540-4640
Practice Address - Street 1:3330 LOMITA BLVD
Practice Address - Street 2:TORRANCE MEMORIAL MEDICAL CENTER
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505
Practice Address - Country:US
Practice Address - Phone:310-528-2996
Practice Address - Fax:310-540-4640
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG79478208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG79478Medicare ID - Type Unspecified
H70265Medicare UPIN