Healthcare Provider Details

I. General information

NPI: 1285993980
Provider Name (Legal Business Name): JERI LYNNE GELERIS F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

7890 HAVEN AVE STE 1
RANCHO CUCAMONGA CA
91730-3051
US

IV. Provider business mailing address

7890 HAVEN AVE STE 1
RANCHO CUCAMONGA CA
91730-3072
US

V. Phone/Fax

Practice location:
  • Phone: 909-581-3051
  • Fax: 909-581-3057
Mailing address:
  • Phone: 909-581-3051
  • Fax: 909-581-3057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: