Healthcare Provider Details

I. General information

NPI: 1770968679
Provider Name (Legal Business Name): KELSI GEORGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2015
Last Update Date: 07/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3265 17TH ST STE 404
SAN FRANCISCO CA
94110-1259
US

IV. Provider business mailing address

6813 NE 142ND ST
VANCOUVER WA
98686-2000
US

V. Phone/Fax

Practice location:
  • Phone: 415-437-3990
  • Fax:
Mailing address:
  • Phone: 360-624-1943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: