Provider Demographics
NPI:1932424587
Name:GEERE, MIMANSA (MD)
Entity Type:Individual
Prefix:DR
First Name:MIMANSA
Middle Name:
Last Name:GEERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MIMA
Other - Middle Name:
Other - Last Name:GEERE MD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:265 MAGNOLIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1201
Mailing Address - Country:US
Mailing Address - Phone:408-685-1681
Mailing Address - Fax:
Practice Address - Street 1:265 MAGNOLIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-2084
Practice Address - Country:US
Practice Address - Phone:415-864-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1308752083P0500X, 133NN1002X, 2083B0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083B0002XAllopathic & Osteopathic PhysiciansPreventive MedicineObesity Medicine
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental Medicine
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education