Provider Demographics
NPI:1477501260
Name:VENDRELL, GERARDO JORGE (MD)
Entity Type:Individual
Prefix:DR
First Name:GERARDO
Middle Name:JORGE
Last Name:VENDRELL
Suffix:
Gender:M
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:#956 FCO. COIMBRE ST.
Mailing Address - Street 2:VILLAS DE RIO CANAS
Mailing Address - City:PONCE
Mailing Address - State:PR
Mailing Address - Zip Code:00728-1929
Mailing Address - Country:US
Mailing Address - Phone:787-812-5631
Mailing Address - Fax:
Practice Address - Street 1:2525 AVE EDUARDO RUBERTE
Practice Address - Street 2:SUITE 111 COLISEO SHOPPING CENTER
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00728-1739
Practice Address - Country:US
Practice Address - Phone:787-812-5631
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14942174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0021856Medicare PIN
PRH95487Medicare UPIN