Provider Demographics
NPI:1538456926
Name:BESHAI, GEORGINA REDA (PA-C)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:REDA
Last Name:BESHAI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-1810
Mailing Address - Country:US
Mailing Address - Phone:714-774-7500
Mailing Address - Fax:714-774-7502
Practice Address - Street 1:801 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-1810
Practice Address - Country:US
Practice Address - Phone:714-774-7500
Practice Address - Fax:714-774-7502
Is Sole Proprietor?:No
Enumeration Date:2011-07-06
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21677363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant