Provider Demographics
NPI:1326403122
Name:LIDOFF, GENEVIEVE (RN)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:LIDOFF
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:286 S 16TH ST
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-2245
Mailing Address - Country:US
Mailing Address - Phone:805-473-7114
Mailing Address - Fax:
Practice Address - Street 1:286 S 16TH ST
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2245
Practice Address - Country:US
Practice Address - Phone:805-473-7114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA787425163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management