Provider Demographics
NPI:1144304684
Name:MAHAFFEY, GERI LYNN (NP)
Entity type:Individual
Prefix:
First Name:GERI
Middle Name:LYNN
Last Name:MAHAFFEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1310 HANNA AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:CORCORAN
Mailing Address - State:CA
Mailing Address - Zip Code:93212-2314
Mailing Address - Country:US
Mailing Address - Phone:559-992-3300
Mailing Address - Fax:559-992-8962
Practice Address - Street 1:1310 HANNA AVE
Practice Address - Street 2:STE 1
Practice Address - City:CORCORAN
Practice Address - State:CA
Practice Address - Zip Code:93212-2314
Practice Address - Country:US
Practice Address - Phone:559-992-3300
Practice Address - Fax:559-992-8962
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF73885174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS88219Medicare UPIN
CAZZZ21564ZMedicare ID - Type Unspecified