Healthcare Provider Details

I. General information

NPI: 1306547757
Provider Name (Legal Business Name): DIANNE GRACE GEORGETTI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/13/2023
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 PARNASSUS AVE STE 908
SAN FRANCISCO CA
94117-3612
US

IV. Provider business mailing address

350 PARNASSUS AVE STE 908
SAN FRANCISCO CA
94117-3612
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2119
  • Fax: 415-353-2406
Mailing address:
  • Phone: 415-353-2119
  • Fax: 415-353-2406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95022480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number706152
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: