MEDICARE: GEMEFA INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1164413910
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEMEFA INC.

Provider Business Mailing Address
First Line	:	PO BOX 1262
Second Line	:
City	:	GURABO
State	:	PR
Zip	:	00778
Country	:	US
Telephone Number	:	787-737-6441
Fax Number	:	787-737-1280

Provider Business Practice Location Address
First Line	:	CALLE ANDRES ARUZ RIVERA OESTE
Second Line	:	#166
City	:	GURABO
State	:	PR
Zip	:	00778
Country	:	US
Telephone Number	:	787-737-6441
Fax Number	:	787-737-1280

Authorized Official
Title or Position	:	PRESIDENT GEMEFA INC
Name	:	MAXIMINO MIRANDA
Credential	:	MD
Telephone Number	:	787-737-6441

Provider Enumeration Date	:	11/01/2005
Last Update Date	:	08/07/2008

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