Healthcare Provider Details

I. General information

NPI: 1831056472
Provider Name (Legal Business Name): GARY CARL GEROZA PTA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2026
Last Update Date: 01/06/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27450 YNEZ RD STE 120
TEMECULA CA
92591-4649
US

IV. Provider business mailing address

36025 ARRAS DR
WINCHESTER CA
92596-8733
US

V. Phone/Fax

Practice location:
  • Phone: 951-498-7540
  • Fax:
Mailing address:
  • Phone: 951-365-7001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225200000X
TaxonomyPhysical Therapy Assistant
License Number54447
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: