Provider Demographics
NPI:1598177016
Name:GEMA JEREZ CORP
Entity Type:Organization
Organization Name:GEMA JEREZ CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HERNANDEZ-JEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:786-360-6812
Mailing Address - Street 1:401 CORAL WAY STE 305
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4926
Mailing Address - Country:US
Mailing Address - Phone:786-360-6812
Mailing Address - Fax:786-360-6845
Practice Address - Street 1:401 CORAL WAY STE 305
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4926
Practice Address - Country:US
Practice Address - Phone:786-360-6812
Practice Address - Fax:786-360-6845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19881122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010493400Medicaid