=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699159657
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHERI LYNN GEIST PA-C, MPAP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/19/2015
-----------------------------------------------------
Last Update Date | 06/01/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5525 ETIWANDA AVE STE 224
-----------------------------------------------------
City | TARZANA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91356-6140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-344-4803
-----------------------------------------------------
Fax | 818-344-4813
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 21311 MADRONA AVE STE 101
-----------------------------------------------------
City | TORRANCE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90503-5970
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax | 310-792-4093
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 60593874
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | 52637
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------