MEDICARE: ROS GABRIEL CALUNGCAGUIN

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	367500000X	Certified Registered Nurse Anesthetist	159527	FL

General Provider Information

NPI Number	:	1144182973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROS GABRIEL CALUNGCAGUIN

Provider Business Mailing Address
First Line	:	11391 SQUARE ST UNIT 1414
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4097
Country	:	US
Telephone Number	:	786-261-5559
Fax Number	:

Provider Business Practice Location Address
First Line	:	11391 SQUARE ST UNIT 1414
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-4097
Country	:	US
Telephone Number	:	786-261-5559
Fax Number	:

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

Provider Enumeration Date	:	12/01/2025
Last Update Date	:	12/28/2025

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