Active NPI
Elisha Gumbo
- Registered Nurse
- Beaumont, CA
National Provider Identifier
1962977371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 768627
- Practice address
- 37657 Brutus Way
Beaumont, CA 92223-8056 - Phone
- (909) 800-4885
- NPI assigned
- Oct 11, 2018
- Last updated
- Oct 14, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 768627 | CA | Primary |
Addresses
Primary practice location
37657 Brutus Way
Beaumont, CA 92223-8056
Mailing address
37657 Brutus Way
Beaumont, CA 92223-8056
Phone (909) 800-4885
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 768627 | CA | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1539216000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1539475200000",
"number": "1962977371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "37657 BRUTUS WAY",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922238056",
"telephone_number": "909-800-4885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "37657 BRUTUS WAY",
"city": "BEAUMONT",
"state": "CA",
"postal_code": "922238056",
"telephone_number": "909-800-4885"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUMBO",
"first_name": "ELISHA",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-10-11",
"last_updated": "2018-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "CA",
"license": "768627",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.