MEDICARE: DR. GERARDO JORGE VENDRELL M.D.

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	174400000X	Specialist	14942	PR

General Provider Information

NPI Number	:	1477501260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERARDO JORGE VENDRELL M.D.

Provider Business Mailing Address
First Line	:	#956 FCO. COIMBRE ST.
Second Line	:	VILLAS DE RIO CANAS
City	:	PONCE
State	:	PR
Zip	:	00728-1929
Country	:	US
Telephone Number	:	787-812-5631
Fax Number	:

Provider Business Practice Location Address
First Line	:	2525 AVE EDUARDO RUBERTE
Second Line	:	SUITE 111 COLISEO SHOPPING CENTER
City	:	PONCE
State	:	PR
Zip	:	00728-1739
Country	:	US
Telephone Number	:	787-812-5631
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/04/2006
Last Update Date	:	02/11/2014

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