Organization
JACK L. GUCCIONE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JACK L. GUCCIONE MD, MPH (DIRECTOR)
(707) 725-8770
Entity
Organization
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
08/29/2006
Last updated
11/19/2012
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