Provider Demographics
NPI:1164402632
Name:GUBA, GERARDO REYES (MD)
Entity Type:Individual
Prefix:
First Name:GERARDO
Middle Name:REYES
Last Name:GUBA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3500 LOMITA BLVD
Mailing Address - Street 2:STE 203
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5021
Mailing Address - Country:US
Mailing Address - Phone:310-534-8164
Mailing Address - Fax:310-534-4267
Practice Address - Street 1:824 E CARSON ST
Practice Address - Street 2:STE 101
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745
Practice Address - Country:US
Practice Address - Phone:310-233-3202
Practice Address - Fax:310-233-3208
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2013-02-06
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Provider Licenses
StateLicense IDTaxonomies
CAA65337207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03445Medicare UPIN
CAWA65337BMedicare PIN