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General NPI Number Information
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NPI Number | 1306587415
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Entity Type | Organization
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Legal Business Name | KUMU HEALTH INC.
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 04/05/2022
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Provider Practice Location Address
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Address Line | 11757 BEACH BLVD STE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6633
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Country | US
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Telephone | 904-531-4556
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Fax | 904-376-7718
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Provider Business Mailing Address
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Address Line | 11757 BEACH BLVD STE 7
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City | JACKSONVILLE
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State | FL
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Zip | 32246-6633
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Country | US
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Telephone | 904-531-4556
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Fax | 904-376-7718
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIEGO FERNANDO GOMEZ
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Credential | PHARMD
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Telephone | 904-531-4556
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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