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General NPI Number Information
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NPI Number | 1891137774
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Entity Type | Individual
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Provider Name | GEORGETTE RENE MUHAMMAD PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/22/2013
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Last Update Date | 03/21/2024
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Provider Practice Location Address
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Address Line | 4445 MAGNOLIA AVE
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City | RIVERSIDE
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State | CA
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Zip | 92501-4135
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Country | US
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Telephone | 951-788-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 15615 TURNBERRY ST
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City | MORENO VALLEY
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State | CA
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Zip | 92555-4901
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Country | US
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Telephone | 95-199-2620
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Fax | 951-992-6201
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA 22985
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA 22985
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License Number State | CA
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