NPIMap

Organization Active NPI

Genesis OBGYN Medical Group Inc.

  • Obstetrics & Gynecology Physician
  • Apple Valley, CA
National Provider Identifier
1164517132
Registry record updated Nov 29, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
A84253 Issued in CA
Legal business name
GENESIS OBGYN MEDICAL GROUP INC.
Practice address
16000 Apple Valley Road
Suite C3
Apple Valley, CA 92307
Phone
(760) 946-3806
Fax
(760) 946-3809
NPI assigned
Oct 4, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Miss Wanda Althea Wilburn, MD
Title
Owner of Medical Practice
Phone
(760) 946-3806

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Obstetrics & Gynecology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207V00000X A84253 CA Primary

Addresses

Primary practice location

16000 Apple Valley Road
Suite C3
Apple Valley, CA 92307

Mailing address

16000 Apple Valley Road
Suite C3
Apple Valley, CA 92307
Phone (760) 946-3806

Other identifiers 1

IdentifierTypeStateIssuer
00A842530MedicaidCA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1322524800000",
    "number": "1164517132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16000 APPLE VALLEY ROAD",
            "address_2": "SUITE C3",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92307",
            "telephone_number": "760-946-3806",
            "fax_number": "760-946-3809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16000 APPLE VALLEY ROAD",
            "address_2": "SUITE C3",
            "city": "APPLE VALLEY",
            "state": "CA",
            "postal_code": "92307",
            "telephone_number": "760-946-3806",
            "fax_number": "760-946-3809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS OBGYN MEDICAL GROUP INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2011-11-29",
        "status": "A",
        "authorized_official_last_name": "WILBURN",
        "authorized_official_first_name": "WANDA",
        "authorized_official_middle_name": "ALTHEA",
        "authorized_official_title_or_position": "OWNER OF MEDICAL PRACTICE",
        "authorized_official_telephone_number": "760-946-3806",
        "authorized_official_name_prefix": "Miss",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "A84253",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A842530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Apple Valley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.