Individual
JOSE GERENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11325 VILLAGE BROOK DR, RIVERVIEW, FL 33579
(888) 501-2586
Mailing address
3680 LAKE CENTER DR 1104, MT DORA, FL 32757
(888) 501-2586
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
233767
FL
376J00000X
Homemaker
233767
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
233767
—
FL
Enumeration date
11/13/2014
Last updated
11/13/2014
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