Healthcare Provider Details

I. General information

NPI: 1821162884
Provider Name (Legal Business Name): GILROY FAMILY MEDICAL GROUP, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9460 NO NAME UNO #115
GILROY CA
95020
US

IV. Provider business mailing address

9460 NO NAME UNO #115
GILROY CA
95020
US

V. Phone/Fax

Practice location:
  • Phone: 408-842-3133
  • Fax: 408-842-2229
Mailing address:
  • Phone: 408-842-3133
  • Fax: 408-842-2229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROGER F LUCERO
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 408-842-3133