Provider Demographics
NPI:1649295635
Name:GENERAL, GERARDO M (MD)
Entity type:Individual
Prefix:
First Name:GERARDO
Middle Name:M
Last Name:GENERAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2735
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91708-2735
Mailing Address - Country:US
Mailing Address - Phone:909-465-6464
Mailing Address - Fax:909-465-9544
Practice Address - Street 1:5385 WALNUT AVE STE 5
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-2605
Practice Address - Country:US
Practice Address - Phone:909-465-6464
Practice Address - Fax:909-465-9544
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA51732207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A517320Medicaid
CA00A517320Medicaid