Provider Demographics
NPI:1639180912
Name:GUMATO, SIXTA MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:SIXTA
Middle Name:MONICA
Last Name:GUMATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 S GASTON ST
Mailing Address - Street 2:
Mailing Address - City:CRANE
Mailing Address - State:TX
Mailing Address - Zip Code:79731-2019
Mailing Address - Country:US
Mailing Address - Phone:432-558-2223
Mailing Address - Fax:432-558-2208
Practice Address - Street 1:103 S GASTON ST
Practice Address - Street 2:
Practice Address - City:CRANE
Practice Address - State:TX
Practice Address - Zip Code:79731-2019
Practice Address - Country:US
Practice Address - Phone:432-558-2223
Practice Address - Fax:432-558-2208
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2009-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2291207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116502904Medicaid
TXP00262327OtherMEDICARE RR PIN
TXP00262327OtherMEDICARE RR PIN
TX611291Medicare PIN