Healthcare Provider Details

I. General information

NPI: 1275699704
Provider Name (Legal Business Name): GERIHEALTHSOLUTIONS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 01/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 GRANT AVE SUITE 150
NOVATO CA
94945-7001
US

IV. Provider business mailing address

750 GRANT AVE SUITE 150
NOVATO CA
94945-7001
US

V. Phone/Fax

Practice location:
  • Phone: 415-899-9800
  • Fax: 415-899-9805
Mailing address:
  • Phone: 415-899-9800
  • Fax: 415-899-9805

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8749
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number8750
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number294
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number11529
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10022
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10811
License Number StateCA
# 7
Primary TaxonomyN
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License Number13815
License Number StateCA
# 8
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number4924
License Number StateCA

VIII. Authorized Official

Name: DEBRA E BAKERJIAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: PHD
Phone: 415-899-9800