Individual
GEORGANN GERVASI-LYTTKENS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C, R.D.C.S.,R.V.T
Contact information
Practice address
2333 MOWRY AVE, SUITE #220, FREMONT, CA 94538-1625
(510) 792-2012
(510) 792-7986
Mailing address
2333 MOWRY AVE, SUITE #220, FREMONT, CA 94538-1625
(510) 792-2012
(510) 792-7986
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA13704
PHYSICIAN ASSIST. LICENSE
CA
Enumeration date
04/20/2007
Last updated
05/16/2016
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