MEDICARE: DR. ASHA GEORGE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY16298	CA

General Provider Information

NPI Number	:	1821122524
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ASHA GEORGE PH.D.

Provider Business Mailing Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	510-769-4106
Fax Number	:

Provider Business Practice Location Address
First Line	:	1080 MARINA VILLAGE PKWY
Second Line	:	100
City	:	ALAMEDA
State	:	CA
Zip	:	94501-6427
Country	:	US
Telephone Number	:	510-769-4106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	11/20/2016

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