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General NPI Number Information
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NPI Number | 1043402019
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Entity Type | Individual
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Provider Name | JORGE LUIS GERONIMO DDS
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Gender | Male
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Dates
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Enumeration Date | 08/14/2007
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Last Update Date | 12/22/2016
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Provider Practice Location Address
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Address Line | 2270 W LINCOLN AVE STE A
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City | ANAHEIM
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State | CA
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Zip | 92801-6545
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Country | US
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Telephone | 714-224-0240
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Fax |
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Provider Business Mailing Address
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Address Line | 2270 W LINCOLN AVE STE A
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City | ANAHEIM
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State | CA
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Zip | 92801-6545
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Country | US
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Telephone | 714-224-0240
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 47897
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License Number State | CA
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