Healthcare Provider Details

I. General information

NPI: 1043813777
Provider Name (Legal Business Name): JOHN ALAN GUMBITA II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 WYE DR
AKRON OH
44303-1118
US

IV. Provider business mailing address

949 WYE DR
AKRON OH
44303-1118
US

V. Phone/Fax

Practice location:
  • Phone: 234-244-9316
  • Fax:
Mailing address:
  • Phone: 234-244-9316
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number7718984
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number7718984
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: