| Provider / Organization | NPI | Date Certified |
|---|---|---|
| GENESIS LICONA | 1871949248 | 2022-06-19 |
Genesis Licona is registered with the National Plan and Provider Enumeration System and has been issued an National Provider Identifier (NPI) of 1871949248. Registration indicates Genesis Licona is a provider of services with a specialization in Student, Health Care, Student in an Organized Health Care Education/Training Program (Student in an Organized Health Care Education/Training Program, ) (All Other Specialties & Provider Types, ) (Student in an Organized Health Care Education/Training Program, Student, Health Care) Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Pediatrics) (Allopathic & Osteopathic Physicians, Pediatrics) (Pediatrics: Neonatal-Perinatal Medicine, ) (Specialist Network, ) (Pediatrics Neonatal-Perinatal Medicine, Allopathic & Osteopathic Physicians) (Pediatrics, ) Access to Pediatric Primary Care Providers (Allopathic & Osteopathic Physicians, Pediatrics) (Allopathic & Osteopathic Physicians, Pediatrics) (Pediatrics: Neonatal-Perinatal Medicine, ) (Specialist Network, ) (Pediatrics Neonatal-Perinatal Medicine, Allopathic & Osteopathic Physicians) (Pediatrics, )
| Entity Type | Individual |
| Provider Name | Genesis Licona MD |
| Practice Office Address | 1 BAYLOR PLZ HOUSTON, TX US |
| Practice Office Telephone | 7138736017 |
| Mailing Address | 6621 FANNIN MC: W6104 HOUSTON, TX 770302358 US |
| Business Telephone | 7138736017 |
| Address | City / State | Phone / Fax |
|---|---|---|
| 1 Baylor Plz | Houston, TX 770303411 | 7138736017 |
| 2200 Childrens Way 8161 DOT | Nashville, TN 372329760 | 6159362555 / 6159363601 |
| Code | Practice | License No State |
|---|---|---|
| 390200000X | Student, Health Care Student in an Organized Health Care Education/Training Program Student in an Organized Health Care Education/Training Program All Other Specialties & Provider Types Student in an Organized Health Care Education/Training Program Student, Health Care | |
| 2080N0001X | Access to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Pediatrics Allopathic & Osteopathic Physicians Pediatrics Pediatrics: Neonatal-Perinatal Medicine Specialist Network Pediatrics Neonatal-Perinatal Medicine Allopathic & Osteopathic Physicians Pediatrics | 59388
TN |
| 2080N0001X PRIMARY | Access to Pediatric Primary Care Providers Allopathic & Osteopathic Physicians Pediatrics Allopathic & Osteopathic Physicians Pediatrics Pediatrics: Neonatal-Perinatal Medicine Specialist Network Pediatrics Neonatal-Perinatal Medicine Allopathic & Osteopathic Physicians Pediatrics | T7286
TX |