Provider Demographics
NPI:1073179040
Name:GUNGAB, JOAN MARIE ASUNCION
Entity Type:Individual
Prefix:
First Name:JOAN MARIE
Middle Name:ASUNCION
Last Name:GUNGAB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1987 KOLO RD
Mailing Address - Street 2:
Mailing Address - City:KILAUEA
Mailing Address - State:HI
Mailing Address - Zip Code:96754-5585
Mailing Address - Country:US
Mailing Address - Phone:619-763-5420
Mailing Address - Fax:
Practice Address - Street 1:1987 KOLO RD
Practice Address - Street 2:
Practice Address - City:KILAUEA
Practice Address - State:HI
Practice Address - Zip Code:96754-5585
Practice Address - Country:US
Practice Address - Phone:619-274-9386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-15
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-92530163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool