Provider Demographics
NPI:1508901232
Name:PEARSON, GEORGE Y (PA-C BS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:Y
Last Name:PEARSON
Suffix:
Gender:M
Credentials:PA-C BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 ACTON ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-2709
Mailing Address - Country:US
Mailing Address - Phone:510-207-4614
Mailing Address - Fax:510-845-3826
Practice Address - Street 1:3108 ACTON ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94702-2709
Practice Address - Country:US
Practice Address - Phone:510-684-4746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11430363AM0700X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health