Provider Demographics
NPI:1972193498
Name:GEMELGA, GERARD (CRNA)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:
Last Name:GEMELGA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:MR
Other - First Name:GERARD
Other - Middle Name:LOUIE
Other - Last Name:GEMELGA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14761 SHETLAND CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7549
Mailing Address - Country:US
Mailing Address - Phone:760-792-8228
Mailing Address - Fax:
Practice Address - Street 1:18300 US HIGHWAY 18
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2206
Practice Address - Country:US
Practice Address - Phone:760-242-2311
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-19
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA134739367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered