MEDICARE: GA MEDICORP LLC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1366380040
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GA MEDICORP LLC

Provider Business Mailing Address
First Line	:	3157 N UNIVERSITY DR STE 103
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2258
Country	:	US
Telephone Number	:	954-881-9852
Fax Number	:	954-852-4314

Provider Business Practice Location Address
First Line	:	3157 N UNIVERSITY DR STE 103
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33024-2258
Country	:	US
Telephone Number	:	954-881-9852
Fax Number	:	954-852-4314

Authorized Official
Title or Position	:	OWNER
Name	:	GERARDO AGUILERA GONZALEZ
Credential	:
Telephone Number	:	954-881-9852

Provider Enumeration Date	:	03/23/2026
Last Update Date	:	03/23/2026

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Directions to “GA MEDICORP LLC ” Practice Location

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