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General NPI Number Information
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NPI Number | 1942440565
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Entity Type | Organization
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Legal Business Name | GERDEZ PROFESSIONAL SERVICES
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Dates
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Enumeration Date | 02/22/2009
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Last Update Date | 01/28/2010
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Provider Practice Location Address
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Address Line | 6367 ALVARADO CT SUITE 201
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City | SAN DIEGO
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State | CA
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Zip | 92120-4915
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Country | US
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Telephone | 619-583-7339
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Fax | 619-287-1662
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Provider Business Mailing Address
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Address Line | 6367 ALVARADO CT SUITE 201
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City | SAN DIEGO
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State | CA
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Zip | 92120-4915
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. SANDRA JETER
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Credential | MSW
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Telephone | 858-882-7173
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2251X0800X
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Taxonomy Name | Orthopedic Physical Therapist
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License Number |
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License Number State |
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