Provider Demographics
NPI:1407538234
Name:GERAISCO LLC
Entity Type:Organization
Organization Name:GERAISCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INTERNAL MEDICINE
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMED
Authorized Official - Middle Name:A
Authorized Official - Last Name:GERAIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:718-737-2286
Mailing Address - Street 1:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85366-2315
Mailing Address - Country:US
Mailing Address - Phone:718-737-2286
Mailing Address - Fax:
Practice Address - Street 1:4052 W 16TH PL
Practice Address - Street 2:
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-3477
Practice Address - Country:US
Practice Address - Phone:718-737-2286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service