Healthcare Provider Details

I. General information

NPI: 1962030932
Provider Name (Legal Business Name): CYNTHIA MICHELLE GERI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 03/27/2020
Certification Date: 03/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 DAVIS RD
COMBINE TX
75159-5857
US

IV. Provider business mailing address

220 DAVIS RD
COMBINE TX
75159-5857
US

V. Phone/Fax

Practice location:
  • Phone: 972-849-3993
  • Fax:
Mailing address:
  • Phone: 972-849-3993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number15995
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: