Healthcare Provider Details

I. General information

NPI: 1720472236
Provider Name (Legal Business Name): GEORGIANA ZACKS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. GEORGIANA MARGARIT

II. Dates (important events)

Enumeration Date: 03/23/2015
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25170 HANCOCK AVE STE 200
MURRIETA CA
92562-5969
US

IV. Provider business mailing address

3880 MURPHY CANYON RD STE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 951-461-9300
  • Fax: 951-461-9399
Mailing address:
  • Phone: 858-636-4300
  • Fax: 858-636-4319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA154809
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: