Healthcare Provider Details

I. General information

NPI: 1801843792
Provider Name (Legal Business Name): ELIZABETH R GUMAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2299 BACON ST
CONCORD CA
94520-2050
US

IV. Provider business mailing address

2862 GEORGIA ST
OAKLAND CA
94602-3222
US

V. Phone/Fax

Practice location:
  • Phone: 925-676-3450
  • Fax:
Mailing address:
  • Phone: 510-390-3991
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number546730
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number12702
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: