Provider Demographics
NPI:1215190004
Name:GUMBAN, JONI PATRICIA (OTR)
Entity Type:Individual
Prefix:MRS
First Name:JONI
Middle Name:PATRICIA
Last Name:GUMBAN
Suffix:
Gender:F
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 GREENE ST
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-6701
Mailing Address - Country:US
Mailing Address - Phone:281-332-4738
Mailing Address - Fax:
Practice Address - Street 1:409 GREENE ST
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-6701
Practice Address - Country:US
Practice Address - Phone:281-332-4738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109088171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider