Provider Demographics
NPI:1720472236
Name:ZACKS, GEORGIANA (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGIANA
Middle Name:
Last Name:ZACKS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:GEORGIANA
Other - Middle Name:
Other - Last Name:MARGARIT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3880 MURPHY CANYON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4411
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:25170 HANCOCK AVE STE 200
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5969
Practice Address - Country:US
Practice Address - Phone:951-461-9300
Practice Address - Fax:951-461-9399
Is Sole Proprietor?:No
Enumeration Date:2015-03-23
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA154809208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program