Provider Demographics
NPI:1528828183
Name:THOMAS, GEORGIANA (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13012 S WILKIE AVE
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90249-1533
Mailing Address - Country:US
Mailing Address - Phone:310-648-4490
Mailing Address - Fax:
Practice Address - Street 1:13012 S WILKIE AVE
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90249-1533
Practice Address - Country:US
Practice Address - Phone:310-648-4490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA752364163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult