Provider Demographics
NPI:1225186000
Name:GEANACOU, CAROLYN A (MD)
Entity type:Individual
Prefix:
First Name:CAROLYN
Middle Name:A
Last Name:GEANACOU
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:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2020 SUTTER PL
Practice Address - Street 2:SUITE 101
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6213
Practice Address - Country:US
Practice Address - Phone:530-750-5830
Practice Address - Fax:530-750-5891
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73440207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine