Provider Demographics
NPI:1992767214
Name:NANOS, GEORGINE (MD)
Entity type:Individual
Prefix:
First Name:GEORGINE
Middle Name:
Last Name:NANOS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:GEORGINE
Other - Middle Name:N
Other - Last Name:JORGENSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:351 SANTA FE DR STE 220
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5137
Mailing Address - Country:US
Mailing Address - Phone:760-701-5463
Mailing Address - Fax:760-452-9425
Practice Address - Street 1:351 SANTA FE DR STE 220
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5137
Practice Address - Country:US
Practice Address - Phone:760-701-5463
Practice Address - Fax:760-452-9425
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950266262084P0015X
CAA85136207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084P0015XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychosomatic Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI48587Medicare UPIN