Healthcare Provider Details

I. General information

NPI: 1306245774
Provider Name (Legal Business Name): GERALYN DA SILVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 08/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12140 NEW YORK RANCH RD
JACKSON CA
95642-9407
US

IV. Provider business mailing address

PO BOX 939
ANGELS CAMP CA
95222-0939
US

V. Phone/Fax

Practice location:
  • Phone: 209-257-2400
  • Fax: 209-257-2403
Mailing address:
  • Phone: 209-754-6240
  • Fax: 209-754-6274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number351468
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: