Jack L. Guccione

Primary specialty

SpecialistTaxonomy code 174400000X

License

G66333 Issued in CA

Legal business name

JACK L. GUCCIONE

Practice address

2404 Newburg Rd
Fortuna, CA 95540-2818

Phone

(707) 725-8770

Fax

(707) 725-8773

NPI assigned

Aug 29, 2006

Last updated

Nov 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Jack L. Guccione, MD, MPHNPI 1174529010

Title

Director

Phone

(707) 725-8770

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jack L Guccione, M.D., MPH

  • Specialist
  • Fortuna, CA
  • NPI 1174529010
  Authorized official Same address or phone

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

{
    "created_epoch": "1156809600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1353283200000",
    "number": "1679681670",
    "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": {
        "organization_name": "JACK L. GUCCIONE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-29",
        "last_updated": "2012-11-19",
        "status": "A",
        "authorized_official_last_name": "GUCCIONE",
        "authorized_official_first_name": "JACK",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "707-725-8770",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, MPH"
    },
    "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 Nov 19, 2012; 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.