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NPI Code Detail

MEDICARE: MR. MARC GABRIEL GUMUCIO NP-C

MEDICARE: MR. MARC GABRIEL GUMUCIO NP-C
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
1363LF0000XFamily Nurse PractitionerCOA.19026OH

General Provider Information

NPI Number : 1528412699
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MARC GABRIEL GUMUCIO NP-C
Provider Business Mailing Address
First Line : 26361 HICKORY LN
Second Line :
City : OLMSTED FALLS
State : OH
Zip : 44138-2733
Country : US
Telephone Number : 216-513-4314
Fax Number :
Provider Business Practice Location Address
First Line : 17840 BAGLEY RD
Second Line :
City : MIDDLEBURG HEIGHTS
State : OH
Zip : 44130-3401
Country : US
Telephone Number : 440-531-6000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2016
Last Update Date : 08/23/2023

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