Provider Demographics
NPI:1487042347
Name:COLVIN, GENEVIEVE THOMAS
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:THOMAS
Last Name:COLVIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13351 RIVERSIDE DR # 587D
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2542
Mailing Address - Country:US
Mailing Address - Phone:310-809-4513
Mailing Address - Fax:
Practice Address - Street 1:13351 RIVERSIDE DR # 587D
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2542
Practice Address - Country:US
Practice Address - Phone:310-809-4513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN