Healthcare Provider Details

I. General information

NPI: 1922794502
Provider Name (Legal Business Name): ANGELA GUMBAREVIC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/17/2023
Certification Date: 04/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

321 1/2 3RD ST NW
BARBERTON OH
44203-2247
US

IV. Provider business mailing address

321 1/2 3RD ST NW
BARBERTON OH
44203-2247
US

V. Phone/Fax

Practice location:
  • Phone: 315-542-2877
  • Fax:
Mailing address:
  • Phone: 315-542-2877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: