Provider Demographics
NPI:1851408116
Name:NERY, GENEROSO SANTOS (MD)
Entity Type:Individual
Prefix:
First Name:GENEROSO
Middle Name:SANTOS
Last Name:NERY
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 1:1183 E FOOTHILL BLVD
Mailing Address - Street 2:SUITE 135
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4079
Mailing Address - Country:US
Mailing Address - Phone:909-931-1368
Mailing Address - Fax:909-931-1372
Practice Address - Street 1:1183 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 135
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4079
Practice Address - Country:US
Practice Address - Phone:909-931-1368
Practice Address - Fax:909-931-1372
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2016-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31007207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A310070Medicaid
CA00A310070Medicaid
CAA26312Medicare UPIN