Individual
DR. JACK L GUCCIONE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D., MPH
Contact information
Practice address
2404 NEWBURG RD, FORTUNA, CA 95540-2818
(707) 725-8770
(707) 725-8773
Mailing address
2404 NEWBURG RD, FORTUNA, CA 95540-2818
(707) 725-8770
(707) 725-8773
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
G66333
CA
Other
Enumeration date
06/24/2005
Last updated
10/25/2007
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