Healthcare Provider Details

I. General information

NPI: 1992767214
Provider Name (Legal Business Name): GEORGINE NANOS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GEORGINE N. JORGENSEN M.D.

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

351 SANTA FE DR STE 220
ENCINITAS CA
92024-5137
US

IV. Provider business mailing address

351 SANTA FE DR STE 220
ENCINITAS CA
92024-5137
US

V. Phone/Fax

Practice location:
  • Phone: 760-701-5463
  • Fax: 760-452-9425
Mailing address:
  • Phone: 760-701-5463
  • Fax: 760-452-9425

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number95026626
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA85136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: