Provider Demographics
NPI:1598084246
Name:LUEVANO, GERARDO I (MED,)
Entity type:Individual
Prefix:MR
First Name:GERARDO
Middle Name:
Last Name:LUEVANO
Suffix:I
Gender:M
Credentials:MED,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 POLK AVE
Mailing Address - Street 2:
Mailing Address - City:CALEXICO
Mailing Address - State:CA
Mailing Address - Zip Code:92231-4332
Mailing Address - Country:US
Mailing Address - Phone:760-235-0279
Mailing Address - Fax:
Practice Address - Street 1:1295 W STATE ST
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-2845
Practice Address - Country:US
Practice Address - Phone:760-482-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-05-20
Last Update Date:2010-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor