Healthcare Provider Details

I. General information

NPI: 1245292440
Provider Name (Legal Business Name): ANTONIO GUMINA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 11/16/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 WIGWAM PKWY STE# 104
HENDERSON NV
89074-7114
US

IV. Provider business mailing address

PO BOX 231930
LAS VEGAS NV
89105-1930
US

V. Phone/Fax

Practice location:
  • Phone: 702-947-1000
  • Fax: 702-947-1001
Mailing address:
  • Phone: 702-947-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9897
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: