Provider Demographics
NPI:1750456562
Name:MARIANO, GERALDINE EUSEBIO (NP)
Entity Type:Individual
Prefix:
First Name:GERALDINE
Middle Name:EUSEBIO
Last Name:MARIANO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 TREESIDE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-2437
Mailing Address - Country:US
Mailing Address - Phone:650-583-8341
Mailing Address - Fax:
Practice Address - Street 1:225 30TH ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-2420
Practice Address - Country:US
Practice Address - Phone:415-550-2242
Practice Address - Fax:415-550-2229
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15985363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology