Provider Demographics
NPI:1457902512
Name:GERONA PORCEL LLC
Entity Type:Organization
Organization Name:GERONA PORCEL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNAL-PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-272-8619
Mailing Address - Street 1:2110 E FLAMINGO RD STE 205
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-5192
Mailing Address - Country:US
Mailing Address - Phone:702-620-5105
Mailing Address - Fax:877-220-2664
Practice Address - Street 1:2110 E FLAMINGO RD STE 205
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5192
Practice Address - Country:US
Practice Address - Phone:702-620-5105
Practice Address - Fax:877-220-2664
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GERONA PORCEL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-09-20
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty