Healthcare Provider Details

I. General information

NPI: 1366061004
Provider Name (Legal Business Name): TOMEKA GUMBS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 E UINTAH ST
COLORADO SPRINGS CO
80903-2514
US

IV. Provider business mailing address

525 E UINTAH ST
COLORADO SPRINGS CO
80903-2514
US

V. Phone/Fax

Practice location:
  • Phone: 719-634-8365
  • Fax:
Mailing address:
  • Phone: 719-634-8365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: