Provider Demographics
NPI:1093827057
Name:GERENA, JOSE (UROLOGIST MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:
Last Name:GERENA
Suffix:
Gender:M
Credentials:UROLOGIST MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11911
Mailing Address - Street 2:CAPARRA STATION
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00922-1911
Mailing Address - Country:US
Mailing Address - Phone:787-307-3367
Mailing Address - Fax:
Practice Address - Street 1:T3-8 CARR 21
Practice Address - Street 2:LAS LOMAS
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921-3312
Practice Address - Country:US
Practice Address - Phone:787-781-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR3728208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRC79366Medicare UPIN