MEDICARE: NANCY GEORGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1386402220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NANCY GEORGE

Provider Business Mailing Address
First Line	:	22930 MARKHAM ST
Second Line	:
City	:	PERRIS
State	:	CA
Zip	:	92570-7962
Country	:	US
Telephone Number	:	951-453-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	6800 INDIANA AVE
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92506-4269
Country	:	US
Telephone Number	:	951-453-3223
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2024
Last Update Date	:	03/06/2024

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Directions to “ NANCY GEORGE ” Practice Location

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