Healthcare Provider Details

I. General information

NPI: 1861325268
Provider Name (Legal Business Name): MARY ANN DI GERONIMO RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 SUNFLOWER CT
SAN RAMON CA
94582-5593
US

IV. Provider business mailing address

625 SUNFLOWER CT
SAN RAMON CA
94582-5593
US

V. Phone/Fax

Practice location:
  • Phone: 925-202-7416
  • Fax:
Mailing address:
  • Phone: 925-202-7416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0102X
TaxonomyMaternal Newborn Registered Nurse
License Number358459
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: