Organization
GENESIS MEDICAL PRACTICE MANAGEMENT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DARYL C. MILLAR (CEO)
(602) 264-2770
Entity
Organization
Contact information
Practice address
4620 N 16TH ST, E-110, PHOENIX, AZ 85016-5121
(602) 264-2770
(866) 534-1701
Mailing address
4620 N 16TH ST, E-110, PHOENIX, AZ 85016-5121
(602) 264-2770
(866) 534-1701
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
12/14/2012
Last updated
12/14/2012
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