DR. JACK L GUCCIONE (NPI# 1174529010) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1174529010 |
| Entity Type | Individual |
| Full Name | DR. JACK L GUCCIONE |
| Credential | M.D., MPH |
| Practice Address |
2404 Newburg Rd Fortuna CA 95540-2818 |
| Practice Telephone | 7077258770 |
| Practice Fax Number | 7077258773 |
| Mailing Telephone | 7077258770 |
| Mailing Fax Number | 7077258773 |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2007-10-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | G66333 | CA | Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336706266 | Jack Peter Guccione | Student in an Organized Health Care Education/Training Program | 101 The City Dr S, Orange, CA 92868-3201 | 2019-05-27 |
| Street Address |
2404 NEWBURG RD |
| City | FORTUNA |
| State | CA |
| Zip Code | 95540-2818 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679681670 | Jack L. Guccione | Specialist | 2404 Newburg Rd, Fortuna, CA 95540-2818 | 2006-08-29 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982234787 | Remi Vista, Inc. | Community/Behavioral Health | 3000 Newburg, Fortuna, CA 95540 | 2020-01-21 |
| 1144867474 | Paula-marie Schneider | Registered Nurse | 3750 Rohnerville Rd., Fortuna, CA 95540 | 2019-12-05 |
| 1609265537 | Nancy Stinson Lollich | Physical Therapy Assistant | 2321 Newburg Road, Fortuna Rehabilitation and Wellness, Fortuna, CA 95540 | 2015-01-15 |
| 1730438151 | Heber House Inc. Dba Dermatology Center | Dermatology | 2404 Newburg Rd., Fortuna, CA 95540 | 2012-08-30 |
| 1104173418 | Michelle Leigh Hoopes | Physician Assistant | 3304 Renner Dr Suite B, Fortuna, CA 95540 | 2012-08-07 |
| 1205181526 | Constance Mitchell | Registered Nurse | Redwood Pediatrics, 3305 Renner Dr, Fortuna, CA 95540 | 2012-07-24 |
| 1730457177 | Joy Nadine Frasier | Counselor | 220 Wilson Ln., Fortuna, CA 95540 | 2011-12-13 |
| 1063791713 | Gardenside Eldercare, LLC | Residential Treatment Facility, Physical Disabilities | 529 9th Street, Fortuna, CA 95540 | 2011-08-12 |
| 1093025173 | Sheri A Jewett | Massage Therapist | 2655 Virginia Court, Fortuna, CA 95540 | 2010-10-07 |
| 1134371339 | Mariana Van Der Merwe | Pharmacist | 725 South Boulevard, Rite Aid Pharmacy, Fortuna, CA 95540 | 2008-10-21 |
| Find all providers in zip 95540 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871666412 | Church of Loving Hands, Inc. | Specialist | 639 11th St, Fortuna, CA 95540-2346 | 2006-11-15 |
| 1770513657 | Galen Wayne Pettey | Specialist | 2600 Newburg Rd, Fortuna, CA 95540-2536 | 2006-07-04 |
| 1285818997 | Aiyana B. Meadows | Specialist | 2600 Newburg Rd, Fortuna, CA 95540-2536 | 2007-12-18 |
| 1255458626 | Jones and Bellah Mds | Specialist | 3304 Renner Dr, Fortuna, CA 95540-3120 | 2007-03-23 |
| 1952433922 | John Mogel | Specialist | 3305 Renner Dr, Fortuna, CA 95540-3119 | 2007-03-12 |
| 1164574083 | Redwood Pediatric Medical Group | Specialist | 3305 Renner Dr, Fortuna, CA 95540-3119 | 2007-01-18 |
| 1740370238 | Ronald Bevan Jones | Specialist | 3304 Renner Dr, Fortuna, CA 95540-3120 | 2006-10-13 |
| 1639275886 | Erika Nmi Rosenberg | Specialist | 3305 Renner Dr, Fortuna, CA 95540-3119 | 2006-09-15 |
| 1790881951 | James John Killfoil | Specialist | 3305 Renner Dr, Fortuna, CA 95540-3119 | 2006-09-15 |
| 1679681670 | Jack L. Guccione | Specialist | 2404 Newburg Rd, Fortuna, CA 95540-2818 | 2006-08-29 |
| Find all providers in FORTUNA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.