Healthcare Provider Details

I. General information

NPI: 1164413910
Provider Name (Legal Business Name): GEMEFA INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2005
Last Update Date: 08/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE ANDRES ARUZ RIVERA OESTE #166
GURABO PR
00778
US

IV. Provider business mailing address

PO BOX 1262
GURABO PR
00778
US

V. Phone/Fax

Practice location:
  • Phone: 787-737-6441
  • Fax: 787-737-1280
Mailing address:
  • Phone: 787-737-6441
  • Fax: 787-737-1280

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: MAXIMINO MIRANDA
Title or Position: PRESIDENT GEMEFA INC
Credential: MD
Phone: 787-737-6441