Provider Demographics
NPI:1528129186
Name:SULIMAN, GERALDINE ANN (PA-C)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:ANN
Last Name:SULIMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:GERALDINE
Other - Middle Name:ANN
Other - Last Name:KEARNEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3001 DOUGLAS BLVD STE 325
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4289
Mailing Address - Country:US
Mailing Address - Phone:916-241-9844
Mailing Address - Fax:916-241-9845
Practice Address - Street 1:3001 DOUGLAS BLVD STE 325
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-4289
Practice Address - Country:US
Practice Address - Phone:916-241-9844
Practice Address - Fax:916-241-9845
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA710511133V00000X, 133VN1004X
CAPA 13268363A00000X
CAPA13268363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
No133VN1004XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Pediatric
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1528129186Medicaid