Organization Active NPI

Gemini Plastic Surgery Associates

  • Plastic and Reconstructive Surgery Physician
  • Rancho Cucamonga, CA
National Provider Identifier
1356938948
Registry record updated Apr 29, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic and Reconstructive Surgery PhysicianTaxonomy code 2086S0122X
Legal business name
GEMINI PLASTIC SURGERY ASSOCIATES
Practice address
10888 Foothill Blvd
Rancho Cucamonga, CA 91730-7651
Phone
(909) 463-0715
Fax
(909) 463-0675
NPI assigned
Dec 29, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 29, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Gemini Plastic Surgery, MD
Title
President
Phone
(909) 463-0715

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic and Reconstructive Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2086S0122X Primary

Addresses

Primary practice location

10888 Foothill Blvd
Rancho Cucamonga, CA 91730-7651

Mailing address

10888 Foothill Blvd
Rancho Cucamonga, CA 91730-7651
Phone (909) 463-0715

Other names 1

  • Gemini Plastic Surgery Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250520000275 CA Part B Supplier - Clinic/Group Practice 4587182977 Receives reassigned benefits from 2 practitioners
Practice locations: Rancho Cucamonga, CA

National Provider Directory

National Provider Directory

Locations

10888 Foothill Blvd
Ste 180
Rancho Cucamonga, CA 91730
Phone (307) 475-8588

12499 Victoria Gardens Ln
Ste 103
Rancho Cucamonga, CA 91739
Phone (909) 463-0715

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1609200000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1745884800000",
    "number": "1356938948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10888 FOOTHILL BLVD",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307651",
            "telephone_number": "909-463-0715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10888 FOOTHILL BLVD",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917307651",
            "telephone_number": "909-463-0715",
            "fax_number": "909-463-0675"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GEMINI PLASTIC SURGERY ASSOCIATES",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-29",
        "last_updated": "2025-04-29",
        "certification_date": "2025-04-29",
        "status": "A",
        "authorized_official_last_name": "SURGERY",
        "authorized_official_first_name": "GEMINI",
        "authorized_official_middle_name": "PLASTIC",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "909-463-0715",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2086S0122X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Surgery, Plastic and Reconstructive Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gemini Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Gemini Plastic Surgery",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.