Provider Demographics
NPI:1184850612
Name:GEORGE, JAYA (NP)
Entity Type:Individual
Prefix:
First Name:JAYA
Middle Name:
Last Name:GEORGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3581 PALMER DR 602
Mailing Address - Street 2:
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682-8238
Mailing Address - Country:US
Mailing Address - Phone:530-672-7000
Mailing Address - Fax:
Practice Address - Street 1:935 PATRICK CIR
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-7503
Practice Address - Country:US
Practice Address - Phone:916-294-9977
Practice Address - Fax:916-294-9977
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18921363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner