Basic Information
| Provider Information | |||||||||
| NPI: | 1326124736 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHEEAN | ||||||||
| FirstName: | GEOFFREY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 402 DICKINSON ST | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921036902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195435300 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 9350 CAMPUS POINT DR | ||||||||
| Address2: | LL-B | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920371300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8586578540 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/27/2006 | ||||||||
| LastUpdateDate: | 01/26/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | A79636 | CA | Y | Other Service Providers | Specialist |
No ID Information.