Provider Demographics
NPI:1437816030
Name:GAMERO-RIVERA, MANLIO ERNESTO (PA-C)
Entity Type:Individual
Prefix:
First Name:MANLIO
Middle Name:ERNESTO
Last Name:GAMERO-RIVERA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 EL DORADO ST APT A
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-6162
Mailing Address - Country:US
Mailing Address - Phone:626-429-7577
Mailing Address - Fax:
Practice Address - Street 1:533020 BASILONE ROAD
Practice Address - Street 2:
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:760-725-7410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2023-06-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant