Provider Demographics
NPI:1679671002
Name:GUMINA, DEBORAH LYNN (MD)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYNN
Last Name:GUMINA
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 1:1125 EAST SPRUCE AVENUE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3330
Mailing Address - Country:US
Mailing Address - Phone:559-450-3901
Mailing Address - Fax:559-450-3903
Practice Address - Street 1:1125 EAST SPRUCE AVENUE
Practice Address - Street 2:SUITE 101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3330
Practice Address - Country:US
Practice Address - Phone:559-450-3901
Practice Address - Fax:559-450-3903
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2013-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74344208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
G38000Medicare UPIN