MEDICARE: GERARDO TAPIA HERNANDEZ NP

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	363LG0600X	Gerontology Nurse Practitioner	AP142338	TX

General Provider Information

NPI Number	:	1760021976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GERARDO TAPIA HERNANDEZ NP

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:	323-467-7119

Provider Business Practice Location Address
First Line	:	3920 CEDAR SPRINGS RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-3518
Country	:	US
Telephone Number	:	214-599-2173
Fax Number	:	214-443-3880

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

Provider Enumeration Date	:	01/06/2020
Last Update Date	:	05/02/2024

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