Provider Demographics
NPI:1528260411
Name:KNOWLES, NEGAR GEULA (MD)
Entity type:Individual
Prefix:
First Name:NEGAR
Middle Name:GEULA
Last Name:KNOWLES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4647 ZION AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-2507
Mailing Address - Country:US
Mailing Address - Phone:619-528-5000
Mailing Address - Fax:
Practice Address - Street 1:4647 ZION AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120-2507
Practice Address - Country:US
Practice Address - Phone:619-528-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010916792085B0100X, 2085R0202X
AZ368742085R0202X
WAMD600824712085R0202X
CAC1407622085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0251429OtherLABOR AND INDUSTRIES-TRA
WAG8882623OtherPTAN-TRA KING CO
WAG8883460OtherPTAN-UAOM
WA0251433OtherLABOR AND INDUSTRIES-UNION AVENUE OPEN MRI
WA0251425OtherLABOR AND INDUSTRIES-MEDICAL IMAGING ON 1ST
WAG8892692OtherPTAN-DOCTORS CLINIC
WAG8882622OtherPTAN-TRA PIERCE CO