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General NPI Number Information
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NPI Number | 1295952034
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Entity Type | Individual
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Provider Name | GEORGANN GERVASI-LYTTKENS PA-C, R.D.C.S.,R.V.T
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Gender | Female
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 05/16/2016
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Provider Practice Location Address
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Address Line | 2333 MOWRY AVE SUITE #220
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City | FREMONT
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State | CA
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Zip | 94538-1625
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Country | US
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Telephone | 510-792-2012
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Fax | 510-792-7986
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Provider Business Mailing Address
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Address Line | 2333 MOWRY AVE SUITE #220
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City | FREMONT
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State | CA
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Zip | 94538-1625
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Country | US
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Telephone | 510-792-2012
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Fax | 510-792-7986
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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