Healthcare Provider Details

I. General information

NPI: 1780813725
Provider Name (Legal Business Name): GEORGIANA GEORGESCU MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2009
Last Update Date: 06/26/2020
Certification Date: 06/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18301 N 79TH AVE STE C136
GLENDALE AZ
85308-8471
US

IV. Provider business mailing address

4531 N 16TH ST STE 114
PHOENIX AZ
85016-5344
US

V. Phone/Fax

Practice location:
  • Phone: 623-249-7551
  • Fax:
Mailing address:
  • Phone: 602-274-0078
  • Fax: 602-266-4477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number47290
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: