Jack L Guccione, M.D., MPH

Primary specialty

SpecialistTaxonomy code 174400000X

License

G66333 Issued in CA

Practice address

2404 Newburg Rd
Fortuna, CA 95540-2818

Phone

(707) 725-8770

Fax

(707) 725-8773

NPI assigned

Jun 24, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1119571200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1193270400000",
    "number": "1174529010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2404 NEWBURG RD",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955402818",
            "telephone_number": "707-725-8770",
            "fax_number": "707-725-8773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2404 NEWBURG RD",
            "city": "FORTUNA",
            "state": "CA",
            "postal_code": "955402818",
            "telephone_number": "707-725-8770",
            "fax_number": "707-725-8773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GUCCIONE",
        "first_name": "JACK",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D., MPH",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-06-24",
        "last_updated": "2007-10-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "CA",
            "license": "G66333",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Fortuna, CA
• Providers in Fortuna, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.