Individual
GENESIS LICONA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1 BAYLOR PLZ, HOUSTON, TX 77030-3411
(713) 873-6017
Mailing address
6621 FANNIN ST, HOUSTON, TX 77030-2358
(713) 873-6017
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
T7286
TX
2080N0001X
Neonatal-Perinatal Medicine Physician
59388
TN
2080N0001X
Neonatal-Perinatal Medicine Physician
Primary
T7286
TX
Other
Enumeration date
05/04/2016
Last updated
11/06/2025
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