Healthcare Provider Details

I. General information

NPI: 1962761924
Provider Name (Legal Business Name): GEMMA JEAN PARADERO JAMENA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39500 LIBERTY ST
FREMONT CA
94538-2211
US

IV. Provider business mailing address

39500 LIBERTY ST
FREMONT CA
94538-2211
US

V. Phone/Fax

Practice location:
  • Phone: 510-770-8040
  • Fax: 510-770-8145
Mailing address:
  • Phone: 510-770-8040
  • Fax: 510-770-8145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA127649
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: