Basic Information
| Provider Information | |||||||||
| NPI: | 1245353309 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GEORGES | ||||||||
| FirstName: | MARIE | ||||||||
| MiddleName: | THERESE | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 31588 RAILROAD CANYON RD | ||||||||
| Address2: | |||||||||
| City: | CANYON LAKE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925879468 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9512912065 | ||||||||
| FaxNumber: | 9514718026 | ||||||||
| Practice Location | |||||||||
| Address1: | 107 N MCKINLEY ST | ||||||||
| Address2: | |||||||||
| City: | CORONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928796561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9513580141 | ||||||||
| FaxNumber: | 8777788365 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2007 | ||||||||
| LastUpdateDate: | 01/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 71005381A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | R135819 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 4704287858 | MI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 18678 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.