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General NPI Number Information
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NPI Number | 1366380040
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Entity Type | Organization
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Legal Business Name | GA MEDICORP LLC
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Dates
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Enumeration Date | 03/23/2026
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Last Update Date | 03/23/2026
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Provider Practice Location Address
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Address Line | 3157 N UNIVERSITY DR STE 103
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2258
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Country | US
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Telephone | 954-881-9852
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Fax | 954-852-4314
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Provider Business Mailing Address
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Address Line | 3157 N UNIVERSITY DR STE 103
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City | HOLLYWOOD
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State | FL
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Zip | 33024-2258
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Country | US
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Telephone | 954-881-9852
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Fax | 954-852-4314
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Authorized Official
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Title or Position | OWNER
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Name | GERARDO AGUILERA GONZALEZ
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Credential |
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Telephone | 954-881-9852
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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