Provider Demographics
NPI:1063038479
Name:GUMPAL, GUMPAL SILVESTRE PINTANIG
Entity Type:Individual
Prefix:
First Name:GUMPAL
Middle Name:SILVESTRE PINTANIG
Last Name:GUMPAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 DOLCE FLORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89178-8270
Mailing Address - Country:US
Mailing Address - Phone:702-301-4015
Mailing Address - Fax:
Practice Address - Street 1:8120 DOLCE FLORE AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89178-8270
Practice Address - Country:US
Practice Address - Phone:702-301-4015
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-22
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
No376J00000XNursing Service Related ProvidersHomemaker
No385H00000XRespite Care FacilityRespite Care