Healthcare Provider Details

I. General information

NPI: 1831039536
Provider Name (Legal Business Name): GERENA MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2026
Last Update Date: 03/31/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE LIZZIE GRAHAM URB LEVITTOWN JR-5
TOA BAJA PR
00949
US

IV. Provider business mailing address

JR5 CALLE LIZZIE GRAHAM
TOA BAJA PR
00949-3637
US

V. Phone/Fax

Practice location:
  • Phone: 787-539-4145
  • Fax:
Mailing address:
  • Phone: 787-539-4145
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND D GERENA
Title or Position: VICE PRESIDENTE
Credential:
Phone: 787-539-4145