Provider Demographics
NPI:1548217011
Name:GERINET PHYSICIAN SERVICES, INC.
Entity Type:Organization
Organization Name:GERINET PHYSICIAN SERVICES, INC.
Other - Org Name:BRISTOL HOSPICE - GREATER LOS ANGELES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/COO
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:E
Authorized Official - Last Name:MAURICIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-325-0175
Mailing Address - Street 1:206 N 2100 W STE 202
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84116-4741
Mailing Address - Country:US
Mailing Address - Phone:801-656-2769
Mailing Address - Fax:801-478-3588
Practice Address - Street 1:4010 WATSON PLAZA DR STE 140
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90712-4047
Practice Address - Country:US
Practice Address - Phone:562-904-6777
Practice Address - Fax:562-904-2154
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHPC51502FMedicaid
CA=========OtherTAXID
CAHPC51502FMedicaid