Healthcare Provider Details

I. General information

NPI: 1639180912
Provider Name (Legal Business Name): SIXTA MONICA GUMATO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2006
Last Update Date: 04/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S GASTON ST
CRANE TX
79731-2019
US

IV. Provider business mailing address

103 S GASTON ST
CRANE TX
79731-2019
US

V. Phone/Fax

Practice location:
  • Phone: 432-558-2223
  • Fax: 432-558-2208
Mailing address:
  • Phone: 432-558-2223
  • Fax: 432-558-2208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberK2291
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: