Georgann Gervasi-Lyttkens, PA-C, R.D.C.S.,R.V.T

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

Practice address

2333 Mowry Ave
Suite #220
Fremont, CA 94538-1625

Phone

(510) 792-2012

Fax

(510) 792-7986

NPI assigned

Apr 20, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Georgann Gervasi Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177027200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463356800000",
    "number": "1295952034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2333 MOWRY AVE",
            "address_2": "SUITE #220",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381625",
            "telephone_number": "510-792-2012",
            "fax_number": "510-792-7986"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2333 MOWRY AVE",
            "address_2": "SUITE #220",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945381625",
            "telephone_number": "510-792-2012",
            "fax_number": "510-792-7986"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GERVASI-LYTTKENS",
        "first_name": "GEORGANN",
        "credential": "PA-C, R.D.C.S.,R.V.T",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-20",
        "last_updated": "2016-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHYSICIAN ASSIST. LICENSE",
            "identifier": "PA13704",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GEORGANN",
            "last_name": "GERVASI",
            "credential": "PA-C, R.D.C.S.,R.V.T",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Shiny Varghese George, RN, MSN
• Gabrielle Lizabeth Gering, DC
• Aldrin Garrido Geronga, F.N.P.
• Rosalie S. Geronimo, DMD.
• Kevin Gersten, MD
• Masoud Ghafoer
• Tearsa Lorene Ghan
• Shareh O Ghani, MD
• Marianne Ghatta, OD
• Shaaban Ghaus

• Medical Physician Assistant in Fremont, CA
• Providers in Fremont, CA by specialty
• Medical Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.