Provider Demographics
NPI:1043813777
Name:GUMBITA, JOHN ALAN II
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ALAN
Last Name:GUMBITA
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:949 WYE DR
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44303-1118
Mailing Address - Country:US
Mailing Address - Phone:234-244-9316
Mailing Address - Fax:
Practice Address - Street 1:949 WYE DR
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44303-1118
Practice Address - Country:US
Practice Address - Phone:234-244-9316
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-17
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7718984347C00000X, 376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
No347C00000XTransportation ServicesPrivate Vehicle