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General NPI Number Information
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NPI Number | 1104367739
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Entity Type | Individual
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Provider Name | GEORGINA GISELLE GRIMM FNP
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Gender | Female
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Dates
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Enumeration Date | 03/15/2017
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Last Update Date | 03/15/2017
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Provider Practice Location Address
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Address Line | 9925 INTERNATIONAL BLVD #5
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City | OAKLAND
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State | CA
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Zip | 94603-2558
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Country | US
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Telephone | 510-777-1177
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Fax | 510-550-2644
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Provider Business Mailing Address
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Address Line | 5018 SHAFTER AVE
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City | OAKLAND
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State | CA
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Zip | 94609-2221
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Country | US
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Telephone | 510-388-3261
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95006100
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License Number State | CA
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