Healthcare Provider Details

I. General information

NPI: 1952538910
Provider Name (Legal Business Name): JINA ANN GEORGE R.D.,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 S MELROSE DR
VISTA CA
92081-6674
US

IV. Provider business mailing address

2035 SAN REMO DR
OCEANSIDE CA
92056-3282
US

V. Phone/Fax

Practice location:
  • Phone: 760-227-2392
  • Fax: 760-388-7705
Mailing address:
  • Phone: 619-985-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number966497
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: