Basic Information
| Provider Information | |||||||||
| NPI: | 1902826894 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GENOBAGA | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | G | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3067 | ||||||||
| Address2: | |||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959923067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5307514784 | ||||||||
| FaxNumber: | 5307514906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 LIVE OAK BLVD | ||||||||
| Address2: | B2 | ||||||||
| City: | YUBA CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 959913454 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306718718 | ||||||||
| FaxNumber: | 5306718725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/20/2006 | ||||||||
| LastUpdateDate: | 04/08/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | A63752 | CA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 1902826894 | 05 | CA | MEDICAID | 00A637520 | 01 | CA | BLUE SHIELD PIN # | OTHER |