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General NPI Number Information
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NPI Number | 1922185784
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Entity Type | Individual
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Provider Name | CANDIDO GERENA JR. PTA
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1893 NE MIAMI GARDENS DR
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City | MIAMI
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State | FL
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Zip | 33179-5035
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Country | US
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Telephone | 305-682-0080
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Fax | 305-682-0775
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Provider Business Mailing Address
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Address Line | 9596 SW 5TH LN
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City | MIAMI
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State | FL
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Zip | 33174-2120
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Country | US
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Telephone | 305-227-5685
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | 1414
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License Number State | FL
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