Healthcare Provider Details

I. General information

NPI: 1932424587
Provider Name (Legal Business Name): MIMANSA GEERE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIMA SHARMA

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E STE 1804
LOS ANGELES CA
90067-2021
US

IV. Provider business mailing address

265 MAGNOLIA AVE SUITE 100
LARKSPUR CA
94939-1201
US

V. Phone/Fax

Practice location:
  • Phone: 623-688-8844
  • Fax:
Mailing address:
  • Phone: 408-685-1681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083B0002X
TaxonomyObesity Medicine (Preventive Medicine) Physician
License NumberA130875
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code133NN1002X
TaxonomyNutrition Education Nutritionist
License NumberA130875
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA130875
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA130875
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: