Provider Demographics
NPI:1508525981
Name:GERARDO, ARTURO L
Entity Type:Individual
Prefix:
First Name:ARTURO
Middle Name:L
Last Name:GERARDO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2364 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:EL CENTRO
Mailing Address - State:CA
Mailing Address - Zip Code:92243-9642
Mailing Address - Country:US
Mailing Address - Phone:760-332-1468
Mailing Address - Fax:
Practice Address - Street 1:2364 S 2ND ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-9642
Practice Address - Country:US
Practice Address - Phone:760-332-1468
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN718782164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse