Healthcare Provider Details

I. General information

NPI: 1467545764
Provider Name (Legal Business Name): GUSTAVO RINCON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7350 INDUSTRIAL PARK BLVD
MENTOR OH
44060-5318
US

IV. Provider business mailing address

7350 INDUSTRIAL PARK BLVD
MENTOR OH
44060-5318
US

V. Phone/Fax

Practice location:
  • Phone: 216-732-9480
  • Fax:
Mailing address:
  • Phone: 216-732-9480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35.034669
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35034669R
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: