Provider Demographics
NPI:1891895611
Name:GERONA, NERIDA S (RPT)
Entity Type:Individual
Prefix:
First Name:NERIDA
Middle Name:S
Last Name:GERONA
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10792 VIA CIMBORIO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-2651
Mailing Address - Country:US
Mailing Address - Phone:619-316-7987
Mailing Address - Fax:760-291-0076
Practice Address - Street 1:651 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3053
Practice Address - Country:US
Practice Address - Phone:760-291-0074
Practice Address - Fax:760-291-0076
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT18929225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00232362OtherRAILROAD MEDICARE
CAPT18929Medicare ID - Type UnspecifiedMEDICARE INDIVIDUAL
CAWPT18929AMedicare PIN