Healthcare Provider Details

I. General information

NPI: 1972193498
Provider Name (Legal Business Name): GERARD GEMELGA CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MR. GERARD LOUIE GEMELGA

II. Dates (important events)

Enumeration Date: 01/19/2021
Last Update Date: 02/14/2022
Certification Date: 02/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18300 US HIGHWAY 18
APPLE VALLEY CA
92307-2206
US

IV. Provider business mailing address

14761 SHETLAND CT
VICTORVILLE CA
92394-7549
US

V. Phone/Fax

Practice location:
  • Phone: 760-242-2311
  • Fax:
Mailing address:
  • Phone: 760-792-8228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number134739
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: