Provider Demographics
NPI:1013910140
Name:O'SHEA, GERALDINE TERESE (DO)
Entity Type:Individual
Prefix:DR
First Name:GERALDINE
Middle Name:TERESE
Last Name:O'SHEA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:235 NEW YORK RANCH RD
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:CA
Mailing Address - Zip Code:95642-2147
Mailing Address - Country:US
Mailing Address - Phone:209-257-1057
Mailing Address - Fax:209-257-1058
Practice Address - Street 1:235 NEW YORK RANCH RD
Practice Address - Street 2:STE B
Practice Address - City:JACKSON
Practice Address - State:CA
Practice Address - Zip Code:95642-2147
Practice Address - Country:US
Practice Address - Phone:209-257-1057
Practice Address - Fax:209-257-1058
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-23
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7363207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX73630Medicaid
CAG31596Medicare UPIN