Healthcare Provider Details

I. General information

NPI: 1538317110
Provider Name (Legal Business Name): SILVIE AMANDA NATALIE GEORGENS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2008
Last Update Date: 02/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR #404
LA MESA CA
91942-3072
US

IV. Provider business mailing address

8851 CENTER DR #404
LA MESA CA
91942-3072
US

V. Phone/Fax

Practice location:
  • Phone: 619-463-1293
  • Fax: 619-463-8230
Mailing address:
  • Phone: 619-463-1293
  • Fax: 619-463-8230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22035
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number924075
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: