Provider Demographics
NPI:1538317110
Name:GEORGENS, SILVIE AMANDA NATALIE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SILVIE
Middle Name:AMANDA NATALIE
Last Name:GEORGENS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8851 CENTER DR
Mailing Address - Street 2:#404
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3072
Mailing Address - Country:US
Mailing Address - Phone:619-463-1293
Mailing Address - Fax:619-463-8230
Practice Address - Street 1:8851 CENTER DR
Practice Address - Street 2:#404
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3072
Practice Address - Country:US
Practice Address - Phone:619-463-1293
Practice Address - Fax:619-463-8230
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA924075133V00000X
CAPA22035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered