Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 95004255 | CA |
NPI | 1043680978 |
---|---|
Provider Name | Bethany Geleris |
First Address | Pomona, CA 91768-1553 |
Second Address | Oakland, CA 94609-1810 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2015 |
Last Update Date | 05/03/2019 |