Provider Demographics
NPI:1346540705
Name:GAVERO, GRETCHENJAN CUBE (DO)
Entity Type:Individual
Prefix:DR
First Name:GRETCHENJAN
Middle Name:CUBE
Last Name:GAVERO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:GRETCHENJAN
Other - Middle Name:CUBE
Other - Last Name:LACTAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1356 LUSITANA ST
Mailing Address - Street 2:4TH FLOOR
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2409
Mailing Address - Country:US
Mailing Address - Phone:808-586-2900
Mailing Address - Fax:
Practice Address - Street 1:1356 LUSITANIA ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2409
Practice Address - Country:US
Practice Address - Phone:808-586-2900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDOS15152084P0800X
CA20A116512084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry