Genesis Family Care Medical Group, Inc.

Primary specialty

Endocrinology, Diabetes & Metabolism PhysicianTaxonomy code 207RE0101X

License

G34101 Issued in CA

Legal business name

GENESIS FAMILY CARE MEDICAL GROUP, INC.

Practice address

1101 N Sepulveda Blvd Ste 102
Manhattan Beach, CA 90266-5962

Phone

(310) 545-6627

Fax

(310) 545-0352

NPI assigned

Oct 3, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Ronald Ruby J.

Title

President

Phone

(310) 545-6627

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Pacific Coast Family Medical Group Doing business as

Locations

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

{
    "created_epoch": "1191369600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1432857600000",
    "number": "1467640409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 N SEPULVEDA BLVD STE 102",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665962",
            "telephone_number": "310-545-6627",
            "fax_number": "310-545-0352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 N SEPULVEDA BLVD STE 102",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902665962",
            "telephone_number": "310-545-6627",
            "fax_number": "310-545-0352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS FAMILY CARE MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-03",
        "last_updated": "2015-05-29",
        "status": "A",
        "authorized_official_last_name": "J.",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "RUBY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "310-545-6627",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "207RE0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Endocrinology, Diabetes & Metabolism",
            "state": "CA",
            "license": "G34101",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0064100",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Pacific Coast Family Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gary M Lazarus OD PHD Apc
• John Gaspari, LCSW
• Heidi L Gastler, DPT
• Michelle Geelhoed, PHYSICIAN ASSISTANT
• Genesis Concierge Medicine
• Jason K Gentile, M.D.
• Aaron P Gerson, D.D.S.
• Tina Ghiassi, NP
• Sara Gilbert, MA LMFT
• Amy A Gimlen, DDS MS

• Endocrinology, Diabetes & Metabolism Physician in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Endocrinology, Diabetes & Metabolism Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 29, 2015; 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.